Long-term behavioral and cognitive outcomes following clipping for incidental unruptured intracranial aneurysms.

Pereira-Filho, Arthur Azambuja; Pereira, Adriana Gutterres; Pereira-Filho, Nelson A.; Lima, L. C. S.; Costa, Jaderson Costa da; Kraemer, Jorge Luiz; Portuguez, Mirna Wetters

doi:10.1037/neu0000010

Cited by 8 publications

(4 citation statements)

References 29 publications

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“…An analysis of hospital records showed interaction effects of hypertension with exposure to surgery in prediction of dementia diagnosis [59]; another reported no such evidence [60]. Three studies on continuous cognitive change reported null or marginal findings [61, 62] or detrimental effects [63] of hypertension. Finally, one study that did not differentiate between POCD and POD reported a lower risk of these outcomes in patients with hypertension [64].…”

Section: Resultsmentioning

confidence: 99%

Hypertension and Risk of Post-Operative Cognitive Dysfunction (POCD): A Systematic Review and Meta-Analysis

Feinkohl¹,

Winterer²,

Pischon³

2017

CPEMH

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Background:Post-operative cognitive dysfunction (POCD) occurs frequently after major surgery. Hypertension is well-established as a risk factor for age-related cognitive impairment, but it is unclear whether or not it also increases the risk of POCD.Objective:To evaluate the role of hypertension in POCD risk in a systematic review and meta-analysis.Method:PubMed, Ovid SP and the Cochrane Database of Systematic Reviews were searched for longitudinal studies of adults undergoing surgery with reporting of hypertension, blood pressure and/or anti-hypertensive treatment associations with POCD as relative risks or odds ratios. Fixed-effects meta-analyses were performed using Review Manager (version 5.3).Results:Twenty-four studies on 4317 patients (mean age 63 years) were included. None of the studies had set out to assess hypertension as a risk factor for POCD. Hypertension was used as a categorical predictor throughout and only 2 studies adjusted for potential confounders. Across all 24 studies, hypertension was not significantly associated with POCD risk (RR 1.01; 95% CI 0.93, 1.09; p=0.82), though among 8 studies with >75% males, we found hypertension associations with a 27% increased risk of POCD (RR 1.27, 95% CI 1.07, 1.49; p=0.005).Conclusion:Our findings do not support the hypothesis that hypertension is a risk factor for POCD. However, since none of the studies included in our analysis were hypothesis-driven and most did not adjust for potential confounders, further systematic investigations are needed to evaluate the role of hypertension in the epidemiology of POCD.

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Section: Resultsmentioning

confidence: 99%

Hypertension and Risk of Post-Operative Cognitive Dysfunction (POCD): A Systematic Review and Meta-Analysis

Feinkohl¹,

Winterer²,

Pischon³

2017

CPEMH

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“…It is generally believed that the rupture and hemorrhage of the aneurysm may have directly damaged REC and orbital gyrus at the base of the frontal lobe [32]. Subsequently, specialists identify temporary and long-term negative effect of REC resection in the categories of language and memory recall in patients after surgery for ruptured ACoA [34,35]. Accordingly, excision of the frontal rectus gyrus, which was previously assumed to not impair limb movement or sensory function, is highly susceptible to cognitive problems.…”

Section: Discussionmentioning

confidence: 99%

Altered Regional Brain Spontaneous Activity and Functional Connectivity in Patients of Non-Acute Subcortical Stroke With versus Without Cognitive Impairment: A Resting-State fMRI Study.

Wang,

Liu,

Yang

et al. 2024

Preprint

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The reasons why not all stroke survivors have cognitive dysfunction are unclear. We hypothesize that resting-state fMRI (rs-fMRI) will reveal differences in regional brain spontaneous activity and functional connectivity (FC) in stroke patients with and without cognitive impairment. We classified 62 first-ever non-acute subcortical stroke patients into two groups: post-stroke with abnormal cognition (PSAC) and with normal cognition (PSNC). Rs-MRI was utilized to assess regional homogeneity (ReHo) in 32 PSAC, 30 PSNC, and 62 age- and sex-matched healthy controls. We set regions with significant alteration within stroke groups as regions of interest and performed the seed-based whole brain FC analysis. A partial correlation analysis examined the relationship between altered ReHo or FC and Montreal Cognitive Assessment (MoCA) scores. Compared to PSNC, PSAC had decreased ReHo in the left gyrus rectus (REC) and increased ReHo in cerebellar lobules (CBL) left IX and right VIII, while FC decreased in PSAC between bilateral REC, and between the left REC and the middle temporal gyrus (MTG). In all stroke patients, ReHo value in the left REC correlated positively and in the CBL correlated negatively with MoCA. All the significant FC correlated with MoCA positively. Regional brain spontaneous activity and FC alteration in the REC, MTG, and cerebellum may be associated with cognitive impairment following non-acute subcortical stroke.

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“…The memory and frontal/executive functions were the most frequently impaired cognitive functions in patients with vascular damage [ 21 , 22 , 23 ]; however, for patients with UIA, previous studies have reported controversial results. Some studies have reported that patients with UIAs did not show a cognitive impairment, [ 24 , 25 , 26 ], whereas others have demonstrated a cognitive impairment after treatment of UIAs [ 4 , 17 ]. A previous study showed that patients with both ruptured and unruptured aneurysms exhibited a decreased cognitive function for word fluency, verbal recall, and frontal lobe function, similar to the findings in the present study [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors Contributing to Cognitive Function in the Acute Stage after Treatment of Intracranial Aneurysms: A Cross-Sectional Study

Kim

Lee²,

Jeon³

et al. 2022

JCM

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Background: The factors affecting cognitive function after treatment of subarachnoid haemorrhage (SAH) can be categorised into aneurysmal factors, procedural factors, and complications. The aim of this study was to investigate which of these factors has greater influence on the cognitive function. Methods: We retrospectively identified 14 patients with unruptured intracranial aneurysms (UIAs) and 34 patients with SAH with mild symptoms at disease onset (Hunt and Hess grade: >3). All patients underwent neuropsychological tests within 35 days of discharge from hospitalisation for treatment. The relationship between the clinical factors and each neuropsychological test score was evaluated using multiple linear regression analysis after controlling for age and years of education. Results: Patients with UIA showed greater cognitive impairment in visual memory and the frontal/executive domains. Hypertension was associated with cognitive impairment. Patients with SAH showed greater cognitive impairment in the visuospatial, verbal memory, and frontal/executive domains. The dome-to-neck ratio, aneurysms located in the posterior circulation, microsurgical clipping, procedure time, anaesthesia duration, and complications were associated with cognitive impairment. Conclusions: Underlying diseases, procedural factors, and complications contributed to cognitive impairment after treatment of intracranial aneurysms. Since the effect of each factor on each cognitive domain was slightly different, a more in-depth study of these effects is needed.

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Long-term behavioral and cognitive outcomes following clipping for incidental unruptured intracranial aneurysms.

Abstract: In either the short or the long term following clipping for patients with incidental unruptured intracranial aneurysms, behavioral and cognitive functions had no significant change from baseline. The intervention demonstrated high efficacy and was associated with a low morbidity rate.

Cited by 8 publications

References 29 publications

Hypertension and Risk of Post-Operative Cognitive Dysfunction (POCD): A Systematic Review and Meta-Analysis

Hypertension and Risk of Post-Operative Cognitive Dysfunction (POCD): A Systematic Review and Meta-Analysis

Altered Regional Brain Spontaneous Activity and Functional Connectivity in Patients of Non-Acute Subcortical Stroke With versus Without Cognitive Impairment: A Resting-State fMRI Study.

Clinical Factors Contributing to Cognitive Function in the Acute Stage after Treatment of Intracranial Aneurysms: A Cross-Sectional Study

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