AGR – 2 Divergence between the Neuropsychological Profile and Psychological Functioning of a Heart-Transplant Candidate: a Case Study

Abstract Objective Neuropsychological evaluations are an integral component in assessing transplant candidacy, as cognitive functioning influences a patient’s ability to understand and follow post-operative care. Contemporaneous psychological assessment is equally as critical, given the possible impact of psychological distress on treatment adherence and health-related decision-making. This case study illustrates the clinical implications of a discrepancy between cognitive and psychological functioning in a transplant candidate. Method A 77-year-old bilingual (Italian and English speaking) patient with a left ventricular assist device (LVAD) underwent a comprehensive neuropsychological evaluation including extensive interviewing and psychological rating scales as part of a multi-disciplinary transplant team assessment. Medical history was significant for heart failure with reduced ejection fraction managed with a LVAD and aortic valve replacement. Results Findings indicated memory and language abilities as grossly intact, arguing against a co-occurring neurodegenerative disorder. Significant difficulties were appreciated in learning, attention, and executive functioning, consistent with frontal-subcortical dysfunction observed in LVAD patients. Depression and anxiety-related symptoms were denied on self-report questionnaires. During intake and extensive interviewing, the patient endorsed daily crying and passive suicidal ideation, including a desire to self-explant the LVAD if unapproved for transplant. Conclusions This case highlights the need for comprehensive assessment of transplant candidates, including psychiatric interviewing, to obtain a holistic view of potential barriers to a successful transplant. Viewing a patient’s neurocognitive or psychological status in isolation may obscure or omit a potential contraindication from prognostic consideration.