Sex Differences in Psychosocial and Neurocognitive Outcomes in Adults with Moderate to Complex Congenital Heart Disease

患有中度至复杂先天性心脏病的成人心理社会和神经认知结果的性别差异

• 批准号: 10825104
• 负责人: Cristina Cabrera-Mino
• 金额: $ 3.98万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-11-15 至 2025-08-14
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10825104
• 关键词: Abbreviations; Academic achievement; Address; Adolescent; Adult; Affect; Age; Age Years; Aging; Analysis of Variance; Anxiety; Attention; Cardiac Surgery procedures; Caring; Caucasians; Chronic; Classification; Clinic; Clinical; Clinical Data; Cognitive; Communities; Comparative Study; Complex; Computerized Medical Record; Congenital Abnormality; Data; Development; Diagnosis; Dimensions; Disparity population; EFRAC; Early Intervention; Education; Employment; Ethnic Origin; Female; Food; Future; Generalized Anxiety Disorder; Goals; Health; Health Surveys; Heart; Hospitalization; Housing; Income; Intelligence; Intervention; Knowledge; Life; Logistic Regressions; Los Angeles; Measurement; Medical; Memory; Menopausal Status; Mental Depression; Methods; Moods; Morbidity - disease rate; Neurocognition; Neurocognitive; Neurocognitive Deficit; Operative Surgical Procedures; Outcome; Participant; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Physical Function; Population; Quality of life; Questionnaires; Reporting; Sample Size; Sampling; Science; Self Care; Self Management; Severity of illness; Sex Differences; Short-Term Memory; Social support; Testing; Unemployment; United States; Ventricular Ejection Fractions; Vulnerable Populations; age related; aged; analog; anxiety symptoms; cognitive testing; comparative; congenital heart disorder; depressive symptoms; design; disability; executive function; follow-up; gender difference; high risk; improved; improved outcome; innovation; male; mental function; middle age; mortality; processing speed; programs; psychosocial; recruit; sex; social health determinants

PROJECT ABSTRACT Congenital Heart Disease (CHD) is the number one birth defect worldwide, with 2.4 million people (1.4 million adults) in the United States. Those figures are expected to double in the next decade with more than 90% of CHD patients reaching adulthood. Despite medical and surgical advancements, 50% of adults with CHD have neurocognitive deficits, depression and heart-focused anxiety that can affect their daily life. However, there are no studies that examine sex differences in psychosocial and neurocognitive outcomes in adults with moderate to complex CHD. Only a few studies have examined either neurocognitive function or psychosocial outcomes in adults with CHD. Those studies have shown deficits in neurocognitive domains such as attention, executive function, processing speed, working memory and intelligence. These deficits place the patient at higher risk for lower educational attainment, unemployment, disability, poor self-care, increased mortality and morbidity, lower quality of life and potential loss to medical follow-up. Unfortunately, small sample sizes in these few studies limited further analysis based on sex / gender differences. To address this critical gap, we will recruit 180 CHD participants between 18 to 40 years of age with a diagnosis of moderate-to-complex CHD from the Ahmanson/UCLA Adult CHD Center. An additional sample of 40 healthy controls will be recruited from the Los Angeles community for comparison. This cross-sectional, comparative study will include measurements to assess neurocognition, anxiety/depression, social determinants of health, mental and physical functioning, social support, and quality of life. Clinical data include ventricular ejection fraction (EF), number of cardiac surgeries, CHD severity and menopause status in females. Specific Aim 1) Examine sex /gender differences in psychosocial, physical functioning, social determinants of health (SDoH), and neurocognitive scores in adults with moderate to complex CHD compared to age-, sex-, and ethnicity-matched controls. We hypothesize that males will have worse neurocognitive scores compared to females with CHD and matched controls, while females with CHD will have worse psychosocial scores compared to males with CHD and match controls. Specific Aim 2) Determine the relationship between neurocognitive scores and sex, clinical factors, SDoH, psychosocial, and physical functioning in adults with moderate-to-complex CHD. We hypothesize that greater number of surgeries, lower EF, worse physical function, higher levels of anxiety and depressive symptoms, less social support, negative SDoH, and male sex will be associated with worse neurocognitive scores in adults with moderate to complex CHD. This study will contribute to new knowledge on the association of sex / gender differences related to neurocognition and psychosocial outcomes in aging adults with CHD. The clinical implications are substantial as results will support the development of targeted interventions to improve neurocognitive and psychosocial outcomes in this high-risk, growing population.

项目摘要 先天性心脏病（CHD）是全世界排名第一的先天缺陷，有240万人（140万人 成人）在美国。这些数字预计将在未来十年中翻一番，超过90％ 冠心病患者成年。尽管有医疗和手术进展，但有50％的冠心病成年人 神经认知缺陷，抑郁症和以心脏为中心的焦虑会影响他们的日常生活。但是，那里 没有研究研究成年人的心理社会和神经认知结果的性别差异 中度至复杂的冠心病。只有少数研究检查了神经认知功能或社会心理 成人冠心病的结果。这些研究表明神经认知领域的缺陷，例如注意力， 执行功能，处理速度，工作记忆和智能。这些赤字将患​​者放在 较低的教育程度，失业，残疾，自我保健不良，死亡率增加和增加的风险更高 发病率，较低的生活质量以及对医疗随访的潜在损失。不幸的是，这些样本量很小 很少有研究限制基于性别 /性别差异的进一步分析。为了解决这个关键的差距，我们将 招募180至40岁之间的180个冠心参与者，诊断为中等复合冠心病 来自Ahmanson/UCLA成人CHD中心。将从 洛杉矶社区进行比较。这项横截面比较研究将包括 评估神经认知，焦虑/抑郁，健康的社会决定因素，精神和 身体功能，社会支持和生活质量。临床数据包括心室射血分数（EF）， 女性心脏手术的数量，冠心病的严重程度和更年期状态。特定目的1）检查性 /性别差异，身体功能，健康的社会决定因素（SDOH）和 与年龄，性别和种族匹配的成年人的神经认知评分相比 控件。我们假设男性与冠心病相比的神经认知得分较差 和匹配的对照，而冠心病的女性与患有冠心病的女性相比将具有更差的心理社会成绩 CHD和比赛控件。具体目标2）确定神经认知得分与性别之间的关系， 中度至复杂性冠心病的成年人中的SDOH，心理社会和身体功能。我们 假设更多的手术，EF较低，身体机能较差，焦虑水平较高和 抑郁症状，社会支持较少，负面SDOH和男性将与更糟 中度至复杂冠心病的成年人的神经认知评分。这项研究将有助于新知识 关于与神经认知和衰老的社会心理结局有关的性别 /性别差异的关联 成人冠心病。临床意义很大，因为结果将支持目标的发展 在这个高风险，增长的人群中，改善神经认知和社会心理结局的干预措施。