Altered frontal white matter microstructure is associated with working memory impairments in adolescents with congenital heart disease: A diffusion tensor imaging study

Melanie Ehrler; Beatrice Latal; Oliver Kretschmar; Michael von Rhein; Ruth O'Gorman Tuura

doi:10.1016/j.nicl.2019.102123

Altered frontal white matter microstructure is associated with working memory impairments in adolescents with congenital heart disease: A diffusion tensor imaging study

Neuroimage Clin. 2020:25:102123. doi: 10.1016/j.nicl.2019.102123. Epub 2019 Dec 16.

Authors

Melanie Ehrler¹, Beatrice Latal¹, Oliver Kretschmar², Michael von Rhein³, Ruth O'Gorman Tuura⁴

Affiliations

¹ Child Development Center, University Children's Hospital Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Switzerland.
² Children's Research Center, University Children's Hospital Zurich, Switzerland; Department of Pediatric Cardiology, University Children's Hospital Zurich, Switzerland.
³ Child Development Center, University Children's Hospital Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Switzerland; Developmental Pediatrics, Center for Social Pediatrics, Cantonal Hospital Winterthur, Switzerland.
⁴ Children's Research Center, University Children's Hospital Zurich, Switzerland; Center for MR Research, University Children's Hospital Zurich, Switzerland. Electronic address: ruth.tuura@kispi.uzh.ch.

Abstract

Children and adolescents with congenital heart disease (CHD) are at risk for mild to moderate cognitive impairments. In particular, impaired working memory performance has been found in CHD patients of all ages. Working memory is an important domain of higher order cognitive function and is crucial for everyday activities, with emerging importance in adolescence. However, the underlying neural correlate of working memory impairments in CHD is not yet fully understood. Diffusion tensor imaging and tract based spatial statistics analyses were conducted in 47 adolescent survivors of childhood cardiopulmonary bypass surgery (24 females) and in 44 healthy controls (24 females) between 11 and 16 years of age (mean age = 13.9, SD = 1.6). Fractional anisotropy (FA) of white matter diffusion was compared between groups and was correlated with working memory performance, derived from the Wechsler Intelligence Scale for Children-IV. CHD patients had significantly poorer working memory compared to controls (p = 0.001). Widespread bilateral reduction in FA was observed in CHD patients compared to healthy controls (threshold-free cluster enhancement (TFCE) corrected p < 0.05). This reduction in FA was present both in cyanotic and acyanotic CHD patients compared to healthy controls (both p < 0.001). The FA reduction in the frontal lobe, mainly in the forceps minor, was associated with poorer working memory performance in both patients with CHD and healthy controls (TFCE corrected p < 0.05). The current findings underline that in CHD patients, irrespective of disease severity, disrupted or delayed maturation of white matter may persist into adolescence and is associated with working memory impairments, particularly if present in the frontal lobe. Adolescence, which is a crucial period for prefrontal brain maturation, may offer a window of opportunity for intervention in order to support the maturation of frontal brain regions and therefore improve higher order cognitive function in patients with CHD.

Keywords: Cognition; Congenital heart disease; Diffusion tensor imaging; Neurodevelopment; Working memory.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Diffusion Tensor Imaging
Female
Frontal Lobe / pathology*
Heart Defects, Congenital / complications*
Humans
Male
Memory Disorders / diagnostic imaging
Memory Disorders / etiology*
Memory, Short-Term / physiology*
White Matter / pathology*