![]() Although the WRAML2 is an excellent assessment tool of general cognition and memory, it lacks many of the desired characteristics for most outpatient applications (short administration time, minimal training for users). The WRAML2 is a cognitive test that takes approximately one hour to administer, with scores validated in patients age five to 90 years. ![]() One commonly accepted instrument is the Wide Range of Assessment Memory and Learning 2nd edition (WRAML2 Sheslow & Adams, 2003). However, consensus on the best instruments to measure cognition in youth with CHD is lacking. Various tools for specific cognitive domains (e.g., intelligence, processing, visual perception, executive functioning) have been used in the adolescent CHD population ( Marino et al., 2012). Currently, there is a lack of brief screening tools to detect cognitive deficits in multiple domains that can be administered in the outpatient setting that could provide objective data needed to refer for a more comprehensive neurocognitive evaluation. It remains unclear to what extent these cognitive deficits-identified at a younger age-persist or worsen into adulthood. In addition, there are no cognitive screening recommendations for the CHD population after transition into adulthood. However, the ability of the medical home provider to objectively screen cognitive function in the clinical setting can be challenging because a wide variety of instruments is available, highly trained test administrators are needed, administration requires time, additional appointments may be needed, families may incur additional out-of-pocket costs, and follow-up recommendations for school may be needed-if an individualized education or 504 plan is indicated. Periodic reevaluation of high-risk children is recommended by the medical home provider at 12 to 24 months, three to five years, and 11-12 years of age ( Marino et al., 2012). In an effort to promote early detection of developmental and cognitive deficits, the American Heart Association and American Academy of Pediatrics recently issued surveillance, screening, and evaluation guidelines for neurodevelopmental assessment, including cognitive factors ( Marino et al., 2012). ![]() ![]() 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). String for correct responses (default is `Correct`)Ī ame with MOCA scores.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. I11Month = "MONTH", i11Year = "YEAR", i11Day = "DAY", i11Place = "PLACE", i11City = "CITY")),ĭelayedRecallTrueCoding = "Correct with No Cue", I6Vigilance = "LETTERS", i6Serial1 = "SERIAL1", i6Serial2 = "SERIAL2", i6Serial3 = "SERIA元", i6Serial4 = "SERIAL4", i6Serial5 = "SERIAL5"), language = c( i7SentenceReptition = paste( "REPEAT", 1: 2, sep = ""), i8VerbalFluency = "FFLUENCY"), abstraction = c( i9Abstraction1 = "ABSTRAN", i9Abstraction2 = "ABSMEAS"),ĭelayedRecall = paste( "DELW", 1: 5, sep = ""), orientation = c( i11Date = "DATE", I4Camel = "CAMEL"), memory = paste( "IMMT", rep( 1: 2, c( 5, 5)), paste( "W", 1: 5, sep = ""), sep = ""), attention = c( i6ForDigitSpan = "DIGFOR", i6BackDigitSpan = "DIGBACK", Qlist = list( visuo = c( i1 = "TRAILS", i2 = "CUBE", i3Contour = "CLOCKCON", i3Numbers = "CLOCKNO", iHands = "CLOCKHAN"), naming = c( i4Lion = "LION", i4Rhino = "RHINO",
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