Open Access

ARTICLE

Identifying self‐reported neurocognitive deficits in the adult with congenital heart disease using a simple screening tool

Ashley Brunmeier^1,2, Michael P Reis³, Michael G. Earing^1,2, Laura Umfleet ⁴, Salil Ginde^1,2, Peter J. Bartz^1,2, Scott Cohen^1,2

1 Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
2 Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
3 Medical College of Wisconsin, Milwaukee, Wisconsin
4 Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin

* Corresponding Author: Scott Cohen MD, Children’s Hospital of Wisconsin, 8915 W. Connell Ct., Milwaukee, WI 53226, USA.

Congenital Heart Disease 2018, 13(5), 728-733. https://doi.org/10.1111/chd.12646

Abstract

Objective: Children with congenital heart disease (CHD) and adults with acquired heart disease are at an increased risk of neurocognitive impairment. The objective of this study was to determine the prevalence of self‐reported neurocognitive impair‐ ment and its risk factors in the adult congenital heart disease (ACHD) population.
Design: The Wisconsin Adult Congenital Heart Disease Program recently began screening ACHD patients to identify those with significant self‐perceived neurocog‐ nitive impairments. Screening consists of using a validated neuro‐oncology screening instrument that has been modified for the ACHD population. Patients who answer this survey in a predetermined fashion consistent with significant self‐perceived neu‐ rocognitive deficits are referred for a formal neurocognitive evaluation. Demographic and clinical information are obtained by chart review.
Results: Three hundred ten patients (49% males) completed the screening process. The average age was 30 years (range: 17–69 years). For the cohort, 57 (18%) patients had no prior cardiac surgeries, 85 (28%) one surgery, 77 (25%) two, and 91 (29%) at least three surgeries. Of those screened, 106 (34%) met criteria for a formal neuro‐ cognitive evaluation. Patients who were referred had undergone a greater number of prior cardiac surgeries (2.2 vs 1.7, P = .008) and were more likely to have severe com‐ plexity CHD (P = .006). Of those patients who were referred, the worst perceived functioning was in math and attention.
Conclusion: There is a high prevalence of ACHD patients with significant self‐per‐ ceived neurocognitive deficits. Simple screening questionnaires may help identify those patients at high risk and allow for timely and appropriate referral for formal neurocognitive evaluation, diagnosis, and therapy.

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