Background and Purpose-Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency characterized by the accumulation of blood in the subarachnoid space surrounding the brain. The acute treatment of aSAH is well documented but less is known about the long-term effects of aSAH on cognition and day-to-day functioning. Methods-We reviewed all studies in the past 10 years that have focused on the effects of aSAH on cognition and day-to-day functioning. Results-Sixty-one empirical studies examining cognitive and functional outcome in patients with aSAH met inclusion criteria. Survivors of aSAH commonly experience deficits in memory, executive function, and language. These cognitive impairments interact to affect patients' day-to-day functioning, including activities of daily living, instrumental activities of daily living, return to work, and quality of life. Deficits in cognition and day-to-day functioning are further compounded by depression, anxiety, fatigue, and sleep disturbances. Conclusions-Much remains to be learned about the brain changes underlying cognitive and functional deficits, including the role of diffuse brain damage and secondary complications like vasospasm and elevated intracranial pressure. A consideration of these issues is necessary to obtain a better understanding of how aSAH affects cognition and day-to-day functioning in the long-term. (Stroke. 2010;41:e519-e536.)

Performance monitoring in the anterior cingulate cortex (ACC) has largely been viewed as a cognitive, computational process devoid of emotion. A growing body of research, however, suggests that performance is moderated by motivational engagement and that a signal generated by the ACC, the error-related negativity (ERN), may partially reflect a distress response to errors. Although suggestive, this past work is hampered by use of correlational designs or by designs that confound affect and cognitive performance. Here we use the misattribution of arousal paradigm--an experimental paradigm that pilot research shows can dissociate affect from cognitive performance--to investigate the extent to which the ERN has arousal properties. Forty university students completed a misattribution of arousal paradigm by consuming a beverage they believed would either increase their anxiety or would have no side effects and then completed a go/no-go task while we recorded ERNs. Results indicate that participants who were given the opportunity to misattribute arousal exhibited a reduced ERN compared with participants who were not given any misattribution cues. This occurred despite no measurable differences in performance on the go/no-go task. In addition, correlations between the ERN and behavior were observed only for participants who did not misattribute their arousal to the placebo beverage. Taken together, these results suggest that the ERN is dissociable from cognitive performance but not negative affect.