Abstract Body: Introduction
Aneurysmal subarachnoid hemorrhage (aSAH) survivors suffer cognitive and behavioral challenges preventing their return to work and social activities. The factors that may affect neuropsychological outcomes after aSAH are not well characterized. This study aimed to analyze the clinical variables associated with the neuropsychological function in a large cohort of aSAH survivors.
Methods
Patients with aSAH admitted to our institution since 2009 were recruited. Clinical variables, modified Rankin score (mRS) at discharge, hemorrhage volume, and the occurrence of vasospasm or new ischemia during hospitalization were collected. Patients underwent Montreal Cognitive Assessment (MoCA). Data was adjusted for sex, age, race, and years of education. Additionaly, patients completed the Beck Depression Inventory and the Stroke Specific Quality of Life questionnaires, while their families completed the Iowa Scale of Personality Changes. Univariate and multivariate analyses were performed to identify predictors of neuropsychological outcomes.
Results
A total of 165 aSAH survivors were enrolled in the study. Short (32/165 patients) - and long-term outcomes (127/165 patients) were analyzed (3-12 months and 1 to 15 years post-aSAH respectively). In the short term, MoCA was significantly worse (<25^th percentile for adjusted data, p 0.003) in patients with high mRS at discharge (median 3, IQR 2) compared to low mRS (median 1, IQR 2, OR:2.14, p 0.006). In the long term, MoCA was significantly worse in patients with higher Hunt and Hess (OR: 1.39, p 0.09), higher modified Fisher grades (OR: 1.29, p 0.1) and in patients who developed new radiological ischemia during hospitalization (OR: 3.42, p 0.03). Larger total hemorrhage volumes were significantly correlated with worse MoCA performance (β: 0.97, p=0.048, figure). Radiological vasospasm (β: -0.40, p 0.006), new ischemia (β: -0.37, p 0.012), and higher Hunt and Hess grades (β: -0.30, p 0.053) were identified as predictors of poorer quality of life. Additionally, lack of stamina and executive personality changes were among the most frequently reported changes by family members post-aSAH for patients.
Conclusion
Short-term cognitive outcomes following aSAH are associated with the mRS at discharge, while long-term cognitive outcomes are predicted by the severity of aSAH as assessed by clinical scales. The development of new ischemia after aSAH independently predicts long-term cognitive outcomes.