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Executive functions in children with heart disease: a systematic review and meta-analysis
William M Jackson1, Nicholas Davis1,2, Johanna Calderon3,4
1Department of Anesthesiology, Columbia University, New York, NY, USA.
Insights
Individuals with congenital heart disease (CHD) experience moderate executive function deficits, including in cognitive flexibility, inhibition, and working memory. Early identification of these executive dysfunctions is crucial for this growing population.
Area of Science:
- Neuroscience
- Psychology
- Cardiology
Background:
- Individuals with congenital heart disease (CHD) are at a higher risk for executive functioning deficits.
- Previous meta-analyses comparing executive functions in CHD patients versus healthy controls have not been reported.
Purpose of the Study:
- To systematically examine and quantify differences in executive functions between individuals with CHD and healthy controls.
Main Methods:
- A systematic review was conducted using data from 1986 to 2020, searching multiple databases including PubMed, EMBASE, and PsycInfo.
- Twenty-eight studies met the inclusion criteria, comparing 7789 individuals with CHD to 8187 healthy controls.
- Data were pooled using a random effects model to calculate standardized mean differences for various executive functions.
Main Results:
- Significant executive function deficits were observed in individuals with CHD across multiple domains.
- Standardized mean differences indicated moderate deficits in cognitive flexibility (-0.628), inhibition (-0.469), working memory (-0.369), and planning/problem-solving (-0.334).
- Summary and reporter-based measures also showed significant deficits, with p < 0.001 for all findings.
Conclusions:
- Individuals with CHD exhibit moderate deficits in executive functions.
- Increased attention is needed to identify and manage executive dysfunction in the growing population of individuals with CHD.
- The study included cross-sectional and observational data, with limitations in quantifying collinearity effects.
Context:
People with CHD are at increased risk for executive functioning deficits. Meta-analyses of these measures in CHD patients compared to healthy controls have not been reported.
Objective:
To examine differences in executive functions in individuals with CHD compared to healthy controls.
Data Sources:
We performed a systematic review of publications from 1 January, 1986 to 15 June, 2020 indexed in PubMed, CINAHL, EMBASE, PsycInfo, Web of Science, and the Cochrane Library.
Study Selection:
Inclusion criteria were (1) studies containing at least one executive function measure; (2) participants were over the age of three.
Data Extraction:
Data extraction and quality assessment were performed independently by two authors. We used a shifting unit-of-analysis approach and pooled data using a random effects model.
Results:
The search yielded 61,217 results. Twenty-eight studies met criteria. A total of 7789 people with CHD were compared with 8187 healthy controls. We found the following standardised mean differences: -0.628 (-0.726, -0.531) for cognitive flexibility and set shifting, -0.469 (-0.606, -0.333) for inhibition, -0.369 (-0.466, -0.273) for working memory, -0.334 (-0.546, -0.121) for planning/problem solving, -0.361 (-0.576, -0.147) for summary measures, and -0.444 (-0.614, -0.274) for reporter-based measures (p < 0.001).
Limitations:
Our analysis consisted of cross-sectional and observational studies. We could not quantify the effect of collinearity.
Conclusions:
Individuals with CHD appear to have at least moderate deficits in executive functions. Given the growing population of people with CHD, more attention should be devoted to identifying executive dysfunction in this vulnerable group.
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