Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage

Mayer, Stephan A.; Kreiter, Kurt T.; Copeland, Daphne; Bernardini, G.; Bates, Joseph E; Peery, Shelley; Claassen, Jan; Du, Yunling; Connolly, E. Sander

doi:10.1212/01.wnl.0000035748.91128.c2

Cited by 257 publications

(170 citation statements)

References 32 publications

(29 reference statements)

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“…Delirium's limited association with mobility is probably why delirium was not associated with good functional outcome at 3 months because the mRS is heavily linked with mobility. Although there are data on cognitive dysfunction after delirium in general (2) and SAH (37), these data demonstrate that Neuro-QOL (and PROMIS, because they are similarly assessed) measures are feasible to obtain in survivors of critical care, and this may be a helpful standard for future outcomes research. QOL data require somewhat more effort from a patient or proxy to report than the validated questionnaire for the mRS. Proxy reporting is a potential source of bias in dependent patients, although other validated tests obtain QOL data by proxy in some cases (38), as we did here.…”

Section: Discussionmentioning

confidence: 97%

Intracerebral Hemorrhage and Delirium Symptoms. Length of Stay, Function, and Quality of Life in a 114-Patient Cohort

Naidech

Beaumont²,

Rosenberg³

et al. 2013

Am J Respir Crit Care Med

105

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Rationale: The prognostic significance of delirium symptoms in intensive care unit (ICU) patients with focal neurologic injury is unclear. Objectives: To determine the relationship between delirium symptoms and subsequent functional outcomes and quality of life (QOL) after intracerebral hemorrhage. Methods: We prospectively enrolled 114 patients. Delirium symptoms were routinely assessed twice daily using the Confusion Assessment Method for the ICU by trained nurses. Functional outcomes were recorded with modified Rankin Scale (scored from 0 [no symptoms] to 6 [dead]), and QOL outcomes with Neuro-QOL at 28 days, 3 months, and 12 months. Measurements and Main Results: Thirty-one (27%) patients had delirium symptoms ("ever delirious"), 67 (59%) were never delirious, and the remainder (14%) had persistent coma. Delirium symptoms were nearly always hypoactive, were detected mean 6 days after intracerebral hemorrhage presentation, and were associated with longer ICU length of stay (mean 3.5 d longer in ever vs. never delirious patients; 95% confidence interval, 1.5-8.3; P ¼ 0.004) after correction for age, admit National Institutes of Health (NIH) Stroke Scale, and any benzodiazepine exposure. Delirium symptoms were associated with increased odds of poor outcome at 28 days (odds ratio, 8.7; 95% confidence interval, 1.4-52.5; P ¼ 0.018) after correction for admission NIH Stroke Scale and age, and with worse QOL in the domains of applied cognition-executive function and fatigue after correcting for the NIH Stroke Scale, age, benzodiazepine exposure, and time of follow-up. Conclusions: After focal neurologic injury, delirium symptoms were common despite low rates of infection and sedation exposure, and were predictive of subsequent worse functional outcomes and lower QOL. Keywords: delirium; outcomes; quality of lifeThe symptoms of delirium, a potential consequence of multiple clinical disease states and physiologic aberrations, include a shift in baseline mental status, inattention, and disorganized thinking or altered level of consciousness. Although nonspecific, this syndrome is an independent predictor of higher mortality (1), longer length of stay (LOS), higher cost of care, and worse long-term cognitive outcomes in medical, surgical, burn, and trauma intensive care unit (ICU) patients (2). There are few such data, however, in ICU patients with focal neurologic injury without systemic illness.Risk factors for delirium symptoms are typically global (infection [3] and intravenous sedation, particularly benzodiazepines [BZDs]) (4, 5) as opposed to focal lesions (e.g., hematoma). Most mechanically ventilated patients are delirious during hospitalization (1), potentially because of the sedation regimen (e.g., BZD infusion), but sedation is typically minimized in neurologically injured patients to permit repeated neurologic assessment that may lead to an acute intervention (6).Screening tests for delirium have been recently validated in neurologically ill patients (7-9), including ischemic stroke (7, 10) and intracerebra...

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Section: Discussionmentioning

confidence: 97%

Intracerebral Hemorrhage and Delirium Symptoms. Length of Stay, Function, and Quality of Life in a 114-Patient Cohort

Naidech

Beaumont²,

Rosenberg³

et al. 2013

Am J Respir Crit Care Med

105

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“…Human SAH results in a wide range of sustained cognitive dysfunction [1,2,25]. Visual and spatial memory is commonly affected.…”

Section: Discussionmentioning

confidence: 99%

“…Cognitive dysfunction affects up to 50-60 % of aneurysmal subarachnoid hemorrhage (SAH) survivors and is a major cause of disability [1,2]. Patients may experience a broad range of deficits involving memory, learning, attention, psychomotor speed, and emotional health [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Cognitive Deficits After Subarachnoid Hemorrhage in Rats

et al. 2016

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Background Cognitive dysfunction can be a long-term complication following subarachnoid hemorrhage (SAH). Preclinical models have been variously characterized to emulate this disorder. This study was designed to directly compare long-term cognitive deficits in the context of similar levels of insult severity in the cisterna magna double-blood (DB) injection versus prechiasmatic blood (PB) injection SAH models. Methods Pilot work identified blood injectate volumes necessary to provide similar mortality rates (20-25 %). Rats were then randomly assigned to DB or PB insults. Saline injection and naïve rats were used as controls. Functional and cognitive outcome was assessed over 35 days. Results DB and PB caused similar transient rotarod deficits. PB rats exhibited decreased anxiety behavior on the elevated plus maze, while anxiety was increased in DB. DB and PB caused differential deficits in the novel object recognition and novel object location tasks. Morris water maze performance was similarly altered in both models (decreased escape latency and increased swimming speed). SAH caused histologic damage in the medial prefrontal cortex, perirhinal cortex, and hippocampal CA1, although severity of injury in the respective regions differed between DB and PB. Conclusion Both SAH models caused long-term cognitive deficits in the context of similar insult severity. Cognitive deficits differed between the two models, as did distribution of histologic injury. Each model offers unique properties and both models may be useful for study of SAH-induced cognitive deficits.

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“…At Week 12, specially trained centralized interviewers conduct a structured telephone interview to obtain scores for the Glasgow Outcome Scale (extended version, GOSE [19,20]), and modified Rankin Scale [21,22]. During this interview, a brief (11-item) standardized evaluation of cognitive functioning (Telephone Interview for Cognitive Status [3,23]) is also performed.…”

Section: Study Assessmentsmentioning

confidence: 99%

“…Mortality among those who reach hospital alive has decreased 0.9% per year since 1980 [1]. Nevertheless, case fatality is still 40% and half of all survivors suffer some form of physical, emotional or cognitive impairment [2][3][4]. The causes of morbidity and mortality are mainly initial effects of the aSAH and delayed ischemic neurological deficit (DIND), which is usually due to cerebral vasospasm [5].…”

mentioning

confidence: 99%

Preventing Vasospasm Improves Outcome After Aneurysmal Subarachnoid Hemorrhage: Rationale and Design of CONSCIOUS-2 and CONSCIOUS-3 Trials

et al. 2010

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Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage

Abstract: Cognitive impairment impacts broadly on functional status, emotional health, and QOL after SAH. The TICS may be a useful alternative to more detailed neuropsychological testing for detecting clinically relevant global cognitive impairment after SAH.

Cited by 257 publications

References 32 publications

Intracerebral Hemorrhage and Delirium Symptoms. Length of Stay, Function, and Quality of Life in a 114-Patient Cohort

Intracerebral Hemorrhage and Delirium Symptoms. Length of Stay, Function, and Quality of Life in a 114-Patient Cohort

Long-Term Cognitive Deficits After Subarachnoid Hemorrhage in Rats

Preventing Vasospasm Improves Outcome After Aneurysmal Subarachnoid Hemorrhage: Rationale and Design of CONSCIOUS-2 and CONSCIOUS-3 Trials

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