The Boston Circulatory Arrest Study - Antecedents and Correlates of Well-Being in Adults with Congenital Heart Disease

波士顿循环骤停研究 - 先天性心脏病成人健康的前因和相关性

• 批准号: 9218952
• 负责人: Michelle Gurvitz
• 金额: $ 75.23万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9218952
• 关键词: Academic achievement; Achievement; Adolescence; Adolescent; Adult; Adverse effects; Age; Anxiety; Behavioral; Biological; Biological Neural Networks; Boston; Brain; Cardiac; Cardiac Surgery procedures; Caring; Catheters; Child; Childhood; Clinical; Cognitive; Complex; Data; Databases; Decision Making; Development; Diagnosis; Dimensions; Educational Status; Employment; Employment Status; Enrollment; Executive Dysfunction; Face; Family; Functional Magnetic Resonance Imaging; Goals; Impaired health; Impairment; Individual; Infant; Informal Social Control; Intervention; Knowledge; Life; Life Expectancy; Magnetic Resonance Imaging; Measures; Medical; Memory; Mental Depression; Mental Health; Mental disorders; Modeling; Monitor; Morbidity - disease rate; Neurobiology; Neurocognitive; Neurocognitive Deficit; Neurologic; Neuropsychology; Operative Surgical Procedures; Outcome; Outcome Measure; Patients; Performance; Play; Population; Quality of life; Rest; Risk; Risk Factors; Short-Term Memory; Social Adjustment; Structure; Study Subject; Survivors; Techniques; Thick; Training; Underemployment; Youth; accurate diagnosis; cognitive function; cohort; congenital heart disorder; critical period; d-transposition of the great arteries; design; effective therapy; emerging adult; executive function; flexibility; follow-up; gray matter; improved; infancy; modifiable risk; neuroimaging; prospective; psychosocial; segregation; skills; social; social cognition; study population; targeted treatment; therapy design; treatment strategy; white matter; young adult

PROJECT SUMMARY Previously lethal, critical congenital heart disease (CHD) can now be treated effectively with surgical, catheter, and medical interventions. The resulting dramatic improvement in life expectancy has brought a major demographic shift, so that adult patients with CHD now outnumber children with CHD, even for complex conditions. Adult survivors are at increased risk of anxiety, depression, social difficulties, lower educational attainment, and underemployment. These psychosocial morbidities may be associated with deficits in executive functions (EFs) and other neurocognitive abilities that are prevalent in children and adolescents with CHD. Deficits in EFs, represented by measures of inhibitory control, working memory, cognitive flexibility, and decision-making, are highly dependent on the integrity of cortical and subcortical neural networks that continue to develop into early adulthood and can have a major adverse impact on self-regulation and management. The goal of our proposal is to bridge the gap in knowledge between known executive function deficits in childhood CHD and adult well-being. We propose to accomplish our goal by studying subjects, now age 24-28 years, who were enrolled as infants in the Boston Circulatory Arrest Study and then studied with respect to neurolopsychological and developmental function at ages 1, 2.5, 4, 8, and 16 years, as well as with brain MRI at 16 years. In Aim 1, we will explore the relationship of EFs to major dimensions of adult well-being. We hypothesize that lower performance on EFs will be related to poorer overall well-being. The outcomes measured to determine well-being will be quality of life, neuropsychological function (e.g. social cognition, memory skills), mental health diagnosis and function (e.g. anxiety, depression), social relatedness, academic achievement, and adult independence (e.g. employment status, medical follow up). In Aim 2, we will determine the relationship of EFs to MRI-derived measures of brain structure, function, and connectivity. We hypothesize that lower performance on EFs will be associated with lower global efficiency (integration) and higher modularity (segregation). We will measure the brain MRI outcomes using global white matter connectivity, regional cortical gray matter thickness, gray matter connectivity measured from interregional correlation in cortical thickness, and functional connectivity as defined by resting state functional magnetic resonance imaging. In Aim 3, we will use longitudinal models to analyze the association of adult well-being with earlier measures of EFs and other neurocognitive and mental health variables, as well as with earlier clinical variables and adolescent neuroimaging. We will analyze associations of adult well-being dimensions with childhood and adolescent EFs, other measures of mental health and cognitive function, adolescent brain MRI findings, and clinical variables. Our ultimate goal is to identify early, modifiable risk factors for adult performance to guide the design of targeted treatment strategies that optimize educational achievement, employability, and quality of life in the burgeoning population of adults with CHD.

项目概要 以前致命的危重先天性心脏病 (CHD) 现在可以通过手术、导管、 和医疗干预措施。由此产生的预期寿命的显着提高带来了重大的 人口结构的变化，使得患有 CHD 的成人患者数量现在超过了患有 CHD 的儿童，即使是复杂的 状况。成年幸存者出现焦虑、抑郁、社交困难、教育程度较低的风险增加 成就和就业不足。这些社会心理疾病可能与以下方面的缺陷有关： 儿童和青少年中普遍存在的执行功能（EF）和其他神经认知能力 冠心病。 EF 缺陷，表现为抑制控制、工作记忆、认知灵活性和 决策的制定高度依赖于皮质和皮质下神经网络的完整性 发展到成年早期，会对自我调节和管理产生重大不利影响。这 我们提案的目标是弥合儿童时期已知的执行功能缺陷之间的知识差距 CHD 和成人福祉。我们建议通过学习现在年龄24-28岁的科目来实现我们的目标， 他们作为婴儿参加了波士顿循环骤停研究，然后进行了以下方面的研究 1、2.5、4、8 和 16 岁时的神经心理和发育功能，以及脑 MRI 16岁时。在目标 1 中，我们将探讨 EF 与成人幸福感主要维度的关系。 我们假设 EF 表现较低与整体健康状况较差有关。结果 衡量幸福感的指标包括生活质量、神经心理功能（例如社会认知、 记忆技能）、心理健康诊断和功能（例如焦虑、抑郁）、社会相关性、学术 成就和成年独立性（例如就业状况、医疗随访）。在目标 2 中，我们将 确定 EF 与 MRI 衍生的大脑结构、功能和功能测量之间的关系 连接性。我们假设 EF 性能较低将与全局效率较低相关 （集成）和更高的模块化（隔离）。我们将使用全局白光测量脑部 MRI 结果 物质连接性、区域皮质灰质厚度、灰质连接性测量 皮质厚度的区域间相关性以及由静息状态功能定义的功能连接 磁共振成像。在目标 3 中，我们将使用纵向模型来分析 通过早期测量 EF 和其他神经认知和心理健康变量来评估成人的福祉，如 以及早期临床变量和青少年神经影像学。我们将分析成人的关联 儿童和青少年 EF 的幸福维度、其他心理健康和认知指标 功能、青少年脑 MRI 结果和临床变量。我们的最终目标是尽早发现可修改的 成人表现的危险因素，指导设计有针对性的治疗策略，优化教育 不断增长的患有先心病的成年人口的成就、就业能力和生活质量。