Evaluation of executive functions in children with rheumatic heart diseases summary

Background: Acute rheumatic fever (ARF) is a multisystemic inflammatory disease that occurs mostly after group A beta-hemolytic streptococcal infection (usually after pharyngitis) in children and young adults. Cellular and humoral autoimmunity, which involves various systems resulting from antigenic mimicking, is responsible for developing significant clinical signs of the disease. The disease's major clinical manifestations are arthritis, carditis, sydemhan chorea, erythema marginatum, and subcutaneous nodules. The most notable complication of ARF is rheumatic heart disease (RHD) that develops after carditis. Most pediatric patients who are being followed up in pediatric cardiology outpatient clinics are RHD children with RHD. Sydenham's chorea (SC), which develops as a result of central nervous system involvement, is one of the major clinical manifestations of ARF. RHD is reported in most of SC cases in children. In recent years, there have been numerous studies reported on executive dysfunction in children with Sydenham's chorea in the literature. To the best of our knowledge, there are no studies in the literature regarding executive functions in children with rheumatic heart disease. The aim and hypothesis of this study are to study the executive functions of children with RHD. We evaluated executive functions in healthy children with the same sociodemographic characteristics as children with RHD to prove this hypothesis. In this study, we hypothesize that children with RHD have executive dysfunctions. Materials and Method: Our study was designed as a cross-sectional randomized study, including children with RHD aged between 12-18 and healthy controls. All of the participates, both in the patient and control groups, were interviewed face to face, and the interviewer also evaluated the questionnaire and scales used in the study through face-to-face interviews. Within the study's scope, the Sociodemographic data form, Executive Functions Behavioral Evaluation Inventory of Parents Form (BRIEF) were filled. Firstly, the difference between the patient and control group participants in terms of age, gender, education level, education level of the parents, and family income level was investigated in our study. Thus, the confounding effect of these factors, which affect executive functions, was excluded. Psychometric measurements and psychiatric interviews were applied after obtaining the informed consent form from the families who participated in the study. The Interview Schedule for School-Age Children for Affective Disorders and Schizophrenia-DSM-5 was applied to all participants for psychiatric diagnostic evaluation. The data obtained were evaluated using appropriate statistical methods. Results: 76.7% (n = 23) of 30 cases with RHD included in our study were female and 23.3% (n = 7) were male individuals. The mean age of the case group was 14.73 ± 1.84 years. The mean age at diagnosis was 11.97 ± 1.72 years. When the case and control groups were compared in terms of family structure, monthly income of their families, presence of medical illness in their sibling, and mental illness in the family, no statistically significant difference was found between the two groups (p> 0.05). It was observed that there were more children in the families of the participants with RHD (p = 0.004), and the education level of the fathers of the patients with RHD was lower (p = 0.04). In our study, no statistically significant difference was found between the patient and control patients when the Digit Span Test, Verbal Fluency Test, Trail Making Test, Wisconsin Card Sorting Test had been done. However, the mean score of "error correction" in the Stroop test was 3.10 ± 2.17 in the patient group and 2.03 ± 1.50 in the control group. A statistically significant difference was found between the groups (p = 0.05), (z: - 1.96). Conclusion: Our study results have shown us that impairments may develop in executive processes without the development of SC in pediatric patients with RHD due to ARF who have a late-onset significant finding of the disease. In our study, only the Stroop test, one of the executive function tests, had a disorder. We attributed the regular penicillin prophylaxis to our patients; short follow-up periods that no impairment was found in other executive dysfunction tests. Stroop test disorders are associated with dorsolateral and/or cingulate prefrontal loop disorders. Therefore, it was suggested that dorsolateral and/or cingulate prefrontal loop dysfunction might first develop in RHD patients before developing SC.