Structural Brain Alterations and Their Associations With Function in Children, Adolescents, and Young Adults With
Marie Brossard-Racine1, Ashok Panigrahy2
1Advances in Brain and Child Development Research Laboratory, Research Institute of McGill University Health Center - Child Heald and Human Development, and School of Physical and Occupational Therapy, Department of Pediatrics - Division of Neonatology and Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
Insights
Congenital heart disease (CHD) survivors often experience neurodevelopmental challenges. Structural brain differences, like smaller volumes, are linked to poorer cognitive function in adolescents and young adults with CHD.
Area of Science:
- Neuroscience
- Pediatric Cardiology
- Developmental Neuroscience
Background:
- Complex congenital heart disease (CHD) surgery survivors often face neurodevelopmental challenges.
- Advances in neuroimaging reveal brain alterations in CHD survivors, but functional consequences remain unclear.
- A broad range of outcomes exists, necessitating a deeper understanding of structure-function relationships.
Purpose of the Study:
- To review current knowledge on structure-function relationships in CHD survivors using structural magnetic resonance imaging (sMRI).
- To identify brain alterations and their association with cognitive outcomes in pediatric and young adult CHD populations.
- To highlight gaps in current research and suggest future directions for interdisciplinary investigations.
Main Methods:
- Systematic review of studies evaluating structure-function relationships in CHD survivors.
- Analysis of data from structural magnetic resonance imaging (sMRI) studies.
- Focus on cognitive outcomes in children, adolescents, and young adults with CHD.
Main Results:
- Smaller total and regional brain volumes are frequently observed in CHD survivors.
- Lower fractional anisotropy in various brain regions is associated with impaired executive functioning and memory.
- These brain differences correlate with poorer cognitive outcomes in adolescents and young adults with CHD.
Conclusions:
- Structural brain alterations are common in CHD survivors and impact cognitive functions like executive functioning and memory.
- Gaps exist in prospective longitudinal studies and the evaluation of diverse functional outcomes beyond cognition.
- Future research should employ multimodal imaging and interdisciplinary approaches to fully understand neurodevelopmental outcomes in CHD survivors.
Abstract:
Most neonates who receive surgery for complex congenital heart disease (CHD) will survive well into adulthood, however, many of them will face functional challenges at one point during their life as a consequence of their atypical neurodevelopment. Recent advances in neuroscience and the increasing accessibility of magnetic resonance imaging have allowed numerous studies to identify the nature and extent of the brain alterations that are particular to survivors with CHD. Nevertheless, and considering that the range of outcomes is broad in this population, the functional consequences of these brain differences is not always evident. In this review, we summarize the present state of knowledge regarding the structure-function relationships evaluated in children, adolescents, and young adults with CHD using structural magnetic resonance imaging. Overall smaller total and regional brain volume, as well as lower fractional anisotropy in numerous brain regions, were frequently associated with lower cognitive outcomes including executive functioning and memory in adolescents and young adults with CHD. However, we identify several gaps in knowledge including the limited number of prospective investigations involving neonatal imaging and follow-up during childhood or adolescence, as well as the need for studies that evaluate a broader range of functional outcomes and not only the cognitive abilities. Future interdisciplinary investigations using multimodal imaging techniques could help address these gaps.
