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) 是全球排名第一的出生缺陷，有 240 万人患有先天性心脏病 (CHD)（140 万 成人）在美国。预计未来十年这些数字将翻一番，其中 90% 以上 冠心病患者已成年。尽管医学和外科手术取得了进步，但 50% 的患有先心病的成年人 神经认知缺陷、抑郁和以心脏为中心的焦虑会影响他们的日常生活。然而，有 没有研究检查成人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心理社会功能 患有 CHD 的成人的结果。这些研究表明神经认知领域存在缺陷，例如注意力、 执行功能、处理速度、工作记忆和智力。这些缺陷使患者处于 教育程度较低、失业、残疾、自我保健能力差、死亡率增加和 发病率、生活质量下降以及可能无法进行医疗随访。不幸的是，这些研究中的样本量很小 很少有研究限制了基于性别差异的进一步分析。为了解决这一关键差距，我们将 招募 180 名年龄在 18 至 40 岁之间、诊断为中度至复杂 CHD 的 CHD 参与者 来自阿曼森/加州大学洛杉矶分校成人 CHD 中心。将另外招募 40 名健康对照样本 洛杉矶社区进行比较。这项横断面比较研究将包括 评估神经认知、焦虑/抑郁、健康、心理和健康的社会决定因素的测量 身体机能、社会支持和生活质量。临床数据包括心室射血分数 (EF)、 心脏手术的数量、冠心病的严重程度和女性的更年期状况。具体目标 1) 检查性别 /社会心理、身体机能、健康社会决定因素 (SDoH) 方面的性别差异，以及 与年龄、性别和种族匹配的中度至复杂先心病成人的神经认知评分相比 控制。我们假设患有先天性心脏病的男性的神经认知评分比女性更差 和匹配的对照组相比，患有先天性心脏病的女性的心理社会评分比患有先天性心脏病的男性更差 CHD 和比赛控制。具体目标 2) 确定神经认知评分与性别之间的关系， 中度至复杂 CHD 成人的临床因素、SDoH、心理社会和身体功能。我们 假设手术次数增多、EF 降低、身体功能恶化、焦虑水平升高 抑郁症状、较少的社会支持、消极的 SDoH 和男性会导致更糟糕的情况 患有中度至复杂先心病的成人的神经认知评分。这项研究将有助于新知识 关于性别/性别差异与衰老过程中神经认知和心理社会结果的关系 患有先心病的成年人。临床意义重大，因为结果将支持靶向药物的开发 旨在改善这一不断增长的高风险人群的神经认知和心理社会结果的干预措施。

项目成果

Neurocognition in adults with congenital heart disease post-cardiac surgery: A systematic review.

先天性心脏病成人心脏手术后的神经认知：系统评价。

• 发表时间: 2024
• 作者: Cabrera;DeVon, Holli A;Aboulhosn, Jamil;Brecht, Mary;Choi, Kristen Rae;Pike, Nancy A
• 通讯作者: Pike, Nancy A