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Education in Heart
Neurocognitive and psychosocial outcomes in adult congenital heart disease: a lifespan approach
  1. Adrienne H Kovacs1,
  2. David C Bellinger2
  1. 1 Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
  2. 2 Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Adrienne H Kovacs, Oregon Health & Science University, Portland, OR 97239, USA; kovacs{at}

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Learning objectives

  • Describe the prevalence and predictors of neurocognitive and psychosocial impairment among adults with congenital heart disease.

  • Improve one’s ability to identify and address neurocognitive and psychosocial impairment in the clinical setting.

  • Summarise the potential role of mental health professionals in the care of adults with congenital heart disease.


In 1964, Glaser recognised that, ‘Despite benefits derived from these remarkable therapeutic gains, children with congenital heart disease face many difficulties in their efforts toward social and emotional adjustment.’1 In 1981, Doucet wrote, ‘The impact of congenital heart disease on the individual would not be limited to the physiological alteration in the heart’s functioning but would affect the whole individual.’2 Recognition of the broader lifestyle implications of congenital heart disease (CHD) for both children and adults is thus not a modern concept. However, what is unique to the current era of CHD care in developed countries is that over 90% of infants born with CHD survive to adulthood, with the number of adults living with CHD now far surpassing the number of children.3 This demands that we expand our definition of successful adult CHD (ACHD) outcomes to include good quality of life, including the best possible neurocognitive and psychosocial functioning, and target our clinical efforts accordingly.

Although neurocognitive and psychosocial outcomes among adults with CHD are often considered independently, this silo-oriented approach ignores their reciprocal interplay. For example, neurocognitive, academic and occupational functioning can be adversely affected if a person is struggling with anxiety or depression. Similarly, neuropsychological deficits can adversely affect social development, impairing one’s ability to establish and sustain satisfying relationships in adulthood. In addition, one cannot fully appreciate adult outcomes without considering their origins in childhood and adolescence. In this review, we thus apply a developmental lifespan perspective to better understand neurocognitive and psychosocial outcomes of …

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  • Contributors Both authors contributed to the preparation of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work.

  • Author note References which include a * are considered to be key references