Moca scores by age12/30/2023 Despite efforts aimed at prevention and early detection to minimize cognitive deficits, many with CHD will have deficits reaching into adulthood, which can impact educational achievement ( Shillingford et al., 2008, Wray & Sensky, 2001) employability ( Niwa et al., 2002), self-care ( McCabe et al., 2015) and health-related quality of life ( Pike et al., 2012 Kahr, Radke, Orwat, Baumgartner, & Diller, 2015). However, many of these deficits may not become apparent until school age, when higher-level organizational skills are required. A distinct pattern of mild cognitive and behavioral impairment associated with problems with reasoning, learning, memory, executive function, inattention, and impulsive behavior, language, and social skills has emereged ( Bellinger et al., 2015 Bellinger et al., 2011 Cassidy, White, DeMaso, Newburger & Bellinger, 2015 von Rhein et al., 2015 Murphy et al., 2015). Mechanisms contributing to cognitive deficits in CHD are complex and multifactorial including hypoxic/ischemic injury triggered by the CHD condition, hypoperfusion during cardiac surgery, and a wide range of genetic, prenatal, and other pre- and postoperative risk factors ( Gaynor et al., 2015 Dominguez, Wernovsky, & Gaynor, 2007 Ballweg, Wernovsky, & Gaynor, 2007). The prevalence of cognitive deficits has been estimated in up to 50% of survivors with complex CHD ( Markowitz, Ichord, Wernosky, Gaynor, & Nicholson, 2007 Wernovsky, 2006). Cognitive deficits are the most common, and potentially the most harmful, sequelae of adolescents and young adults with congenital heart disease (CHD) who have undergone surgical palliation.
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