Cognitive Impairment, Functional Outcome, and Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Eagles, Matthew E; Tso, Michael K; Macdonald, R. Loch

doi:10.1016/j.wneu.2018.12.152

Cited by 50 publications

(53 citation statements)

References 24 publications

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“…It has been 25 years since Hütter and Gilsbach highlighted that six months post-aSAH, neuropsychological deficits were frequent even among SAH patients that seemed to fare well. [6] Since then, similar findings have been reported by several other research groups [11,34,35]. However, we found only one study that evaluated the incidence of NPDs in patients with favorable functional outcome at the early stages after aSAH.…”

Section: Discussionsupporting

confidence: 86%

“…The sensitivity for milder NPDs is reportedly high, and the tool has therefore been graded as superior to other commonly used cognitive screening tools, such as MMSE [19,26]. In fact, in the recent study of 337 aSAH patients, Eagles et al [35] concluded that although MMSE scores varied in favorable outcome patients (mRS 0-2) 12 weeks after aSAH, more sensitive variables, [20,27,36]. The first study revealed a low association between the MoCA (measured at a subacute phase (2-4 weeks) after aSAH) and unfavorable functional outcome (mRS 3-5) at one year [36].…”

Section: Discussionmentioning

confidence: 99%

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Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage

et al. 2019

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Background Although most aneurysmal subarachnoid hemorrhage (aSAH) patients suffer from neuropsychological disabilities, outcome estimation is commonly based only on functional disability scales such as the modified Rankin Scale (mRS). Moreover, early neuropsychological screening tools are not used routinely. Objective To study whether two simple neuropsychological screening tools identify neuropsychological deficits (NPDs), among aSAH patients categorized with favorable outcome (mRS 0-2) at discharge. Methods We reviewed 170 consecutive aSAH patients that were registered in a prospective institutional database. We included all patients graded by the mRS at discharge, and who had additionally been evaluated by a neuropsychologist and/or occupational therapist using the Montreal Cognitive Assessment (MoCA) and/or Rapid Evaluation of Cognitive Function (ERFC). The proportion of patients with scores indicative of NPDs in each test were reported, and spearman correlation tests calculated the coefficients between the both neuropsychological test results and the mRS. Results Of the 42 patients (24.7%) that were evaluated by at least one neuropsychological test, 34 (81.0%) were rated mRS 0-2 at discharge. Among these 34 patients, NPDs were identified in 14 (53.9%) according to the MoCA and 8 (66.7%) according to the ERFC. The mRS score was not correlated with the performance in the MoCA or ERFC. Conclusion The two screening tools implemented here frequently identified NPDs among aSAH patients that were categorized with favorable outcome according to the mRS. Our results suggest that MoCA or ERFC could be used to screen early NPDs in favorable outcome patients, who in turn might benefit from early neuropsychological rehabilitation.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage

et al. 2019

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“…The loss of productive life years due to aSAH is as great as that for cerebral infarction because it frequently affects patients younger than 65 years of age (3). Delayed ischemic neurological deficit (DIND) complicates aSAH in one-third of cases and is a strong risk factor for unfavorable neurological outcomes, defining an unmet need for therapeutic innovation (4,5).…”

Section: Introductionmentioning

confidence: 99%

Haptoglobin administration into the subarachnoid space prevents hemoglobin-induced cerebral vasospasm

Hugelshofer

Buzzi

Schaer

et al. 2019

Journal of Clinical Investigation

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Statistics. We used JMP software from SAS (versions 13 or 14) for all analyses. Data are presented with all data points plotted. Overlayed diamonds represent mean, 95% CI, and overlap marks (horizontal lines above and below the mean line), which define statistical significant difference between groups if not overlapping (P < 0.05). Groups were compared with 1-way ANOVA, applying a Tukey-Kramer posttest correcting for multiple comparisons. A P value of less than 0.05 was considered statistically significant.Study approval. All animal studies were approved by the cantonal veterinary authorities "Kantonale Tierversuchskommission Zürich." The clinical study (CSF sampling) was approved by the local ethical review board of the Kanton of Zurich, and written consent was obtained from all patients or their legal representatives.

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“…Aneurysmatic subarachnoid hemorrhage (aSAH) is caused by rupture of an intracranial aneurysm and leads to significant long-term morbidity. As many cases of aSAH occur at a relatively young age with peak incidence at 55 years of age, many survivors are faced with limitations in their everyday life for decades [1][2][3][4]. Besides physical impairments, neuropsychological deficits have been recognized as one of the main factors affecting patient's quality of life; however, even though many outcome assessment tools like the Montreal Cognitive Assessment (MoCA) and the Mini-Mental Status Evaluation (MMSE), different memory tests like the Wechsler Memory Scale or the California Verbal Learning Test as well as tests of executive function, such as the Wisconsin Card Sorting Task, have been evaluated, it has been difficult to recognize subtle cognitive deficits by means of gross neurological measures [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

The neuropsychological assessment battery (NAB) is a valuable tool for evaluating neuropsychological outcome after aneurysmatic subarachnoid hemorrhage

et al. 2020

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Background Detecting and treating neuropsychological deficits after aneurysmatic subarachnoid hemorrhage (aSAH) play a key role in regaining independence; however, detecting deficits relevant to social and professional reintegration has been difficult and optimal timing of assessments remains unclear. Therefore, we evaluated the feasibility of administering the Neuropsychological Assessment Battery screening module (NAB-S) to patients with aSAH, assessed its value in predicting the ability to return to work and characterized clinical as well as neuropsychological recovery over the period of 24 months. Methods A total of 104 consecutive patients treated for aSAH were recruited. After acute treatment, follow up visits were conducted at 3, 12 and 24 months after the hemorrhage. NAB-S, Montreal Cognitive Assessment (MoCA) and physical examination were performed at each follow up visit. Results The NAB-S could be administered to 64.9, 75.9 and 88.9% of the patients at 3, 12 and 24 months, respectively. Moderate impairment of two or more neuropsychological domains (e.g speech, executive function, etc.) significantly correlated with inability to return to work at 12 and 24 months as well as poor outcome assessed by the extended Glasgow Outcome Scale (GOSE) at 3, 12 and 24 months. The number of patients with favorable outcomes significantly increased from 25.5% at discharge to 56.5 and 57.1% at 3 and 12 months, respectively, and further increased to 74.1% after 24 months. Conclusion The NAB-S can be administered to the majority of patients with aSAH and can effectively detect clinically relevant neuropsychological deficits. Clinical recovery after aSAH continues for at least 24 months after the hemorrhage which should be considered in the design of future clinical trials.

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Cognitive Impairment, Functional Outcome, and Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Cited by 50 publications

References 24 publications

Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage

Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage

Haptoglobin administration into the subarachnoid space prevents hemoglobin-induced cerebral vasospasm

The neuropsychological assessment battery (NAB) is a valuable tool for evaluating neuropsychological outcome after aneurysmatic subarachnoid hemorrhage

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