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）是世界范围内排名第一的出生缺陷，有240万人（140万人） 成年人）在美国。这些数字预计将在未来十年翻一番，超过90%的 成年CHD患者。尽管医学和外科手术取得了进步，但50%的成人CHD患者 神经认知缺陷、抑郁和以心脏为中心的焦虑，这些都可能影响他们的日常生活。但 目前还没有研究检查患有糖尿病的成年人在心理社会和神经认知结果方面的性别差异。 中度至复杂CHD。只有少数研究检查了神经认知功能或心理社会功能 成人CHD患者的结局。这些研究表明，神经认知领域的缺陷，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 受教育程度较低、失业、残疾、自我照顾能力差、死亡率上升和 发病率、生活质量降低和可能丧失医疗随访。不幸的是，这些小样本量 少数研究限制了基于性别/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岁之间的CHD参与者，诊断为中度至复杂CHD Ahmanson/UCLA成人CHD中心将从以下地区招募另外40名健康对照样本： 洛杉矶社区进行比较。这项横向比较研究将包括 评估神经认知、焦虑/抑郁、健康的社会决定因素、精神和心理健康的测量方法， 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）， 女性心脏手术次数、冠心病严重程度和绝经状况。具体目标1）检查性别 /社会心理、身体功能、健康的社会决定因素方面的性别差异，以及 与年龄、性别和种族匹配的中度至复杂CHD成人患者相比， 对照我们假设男性冠心病患者的神经认知评分比女性差 和匹配的对照组，而女性冠心病将有更差的心理社会评分相比，男性 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， 临床因素、SDoH、心理社会和身体功能在成人中度至复杂CHD患者中的作用。我们 假设手术次数越多，EF越低，身体功能越差，焦虑程度越高， 抑郁症状、较少的社会支持、阴性SDoH和男性性别将与更糟的 中度至复杂CHD成人的神经认知评分。这项研究将有助于新的知识 关于老龄化中与神经认知和心理社会结果相关的性别/性别差异的关联 患有CHD的成年人。临床意义是实质性的，因为结果将支持靶向治疗的发展。 干预措施，以改善这一高风险，不断增长的人口的神经认知和心理社会结果。