Prevalence of Cognitive Impairments in Patients with Good Functional Outcome in Late Phase Subarachnoid Hemorrhage

Abstract

Prior studies have shown high prevalence of neuropsychological deficits after aneurysmal subarachnoid hemorrhage; however, few studies detect cognitive impairments in patients with good functional outcome, measured whith Rankin Modified Scale, in the late phase of subarachnoid hemorrhage. We confirmed a high prevalence of alterations in neuropsychological tests in 44 patients with Rankin Modified ≤ 2. We proposed the application of simple and fast tests that allowed us to detect impairments with precision similar to that of complex cognitive batteries used in previous studies. We also attempt to confirm statistical association between factors that could be related to poor cognitive outcome, like Hunt-Hess scale classification, bleeding intensity measured with Fisher scale, therapeutic type (microsurgery ou embolization), and aneurysm localization; however, there was no significance.

Resumo

Estudos anteriores mostraram que a prevalência de déficits neuropsicológicos após hemorragia subaracnóide aneurismática é alto, mas poucos estudos detectaram alterações cognitivas em pacientes com bom desfecho funcional, medido através da escada de Rankin Modificada, na fase tardia da hemorragia subaracnóide. O estudo confirmou em 44 pacientes com RankiN Modificado ≤ 2 a alta prevalência de alterações em testes neuropsicológicos. Propusemos a aplicação de testes simples e rápidos, capazes de detectar alterações, com precisão semelhante a baterias cognitivas complexas utilizadas em estudos anteriores. Nós também avaliamos a associação estatística entre alguns fatores como a escala de Hunt-Hess (HH), a intensidade do sangramento pela escala de Fisher, tipo de tratamento (microcirurgia ou embolização) e localização do aneurisma, ao pior desempenho cognitivo, no entanto não houve significância.

Keywords

subarachnoid hemorrhage - cognition - embolization - therapeutic - microsurgery - clinical evolution

Palavras-chave

hemorragia subaracnoide - cognição - embolização terapêutica - microcirurgia - evolução clínica

• References

• 1 Al-Khindi T, Macdonald RL, Schweizer TA. Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. Stroke 2010; 41 (8) e519-e536
• 2 Berry E, Jones RA, West CG, Brown JD. Outcome of subarachnoid haemorrhage. An analysis of surgical variables, cognitive and emotional sequelae related to SPECT scanning. Br J Neurosurg 1997; 11 (5) 378-387
• 3 Haley Jr EC. Measuring cognitive outcome after subarachnoid hemorrhage. Ann Neurol 2006; 60 (5) 502-504
• 4 Quinn TJ, Dawson J, Walters MR, Lees KR. Functional outcome measures in contemporary stroke trials. Int J Stroke 2009; 4 (3) 200-205
• 5 Wong GKC, Wong R, Mok V, Wong A, Poon WS. Natural history and medical treatment of cognitive dysfunction after spontaneous subarachnoid haemorrhage: review of current literature with respect to aneurysm treatment. J Neurol Sci 2010; 299 (1–2) 5-8
• 6 Enciu A-M, Constantinescu SN, Popescu LM, Mureşanu DF, Popescu BO. Neurobiology of vascular dementia. J Aging Res 2011; 2011: 401604
• 7 Haug T, Sorteberg A, Sorteberg W, Lindegaard K-F, Lundar T, Finset A. Cognitive outcome after aneurysmal subarachnoid hemorrhage: time course of recovery and relationship to clinical, radiological, and management parameters. Neurosurgery 2007; 60 (4) 649-656 , discussion 656–657
• 8 Mayer SA, Kreiter KT, Copeland D , et al. Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage. Neurology 2002; 59 (11) 1750-1758
• 9 Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale: a systematic review. Stroke 2009; 40 (10) 3393-3395
• 10 Ravnik J, Starovasnik B, Sesok S , et al. Long-term cognitive deficits in patients with good outcomes after aneurysmal subarachnoid hemorrhage from anterior communicating artery. Croat Med J 2006; 47 (2) 253-263
• 11 Kreiter KT, Copeland D, Bernardini GL , et al. Predictors of cognitive dysfunction after subarachnoid hemorrhage. Stroke 2002; 33 (1) 200-208
• 12 Nitrini R, Lefèvre BH, Mathias SC , et al. Neuropsychological tests of simple application for diagnosing dementia. Arq Neuropsiquiatr 1994; 52 (4) 457-465
• 13 Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Suggestions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003; 61 (3B): 777-781
• 14 Greebe P, Rinkel GJE, Hop JW, Visser-Meily JMA, Algra A. Functional outcome and quality of life 5 and 12.5 years after aneurysmal subarachnoid haemorrhage. J Neurol 2010; 257 (12) 2059-2064
• 15 Hütter BO, Gilsbach JM. Which neuropsychological deficits are hidden behind a good outcome (Glasgow = I) after aneurysmal subarachnoid hemorrhage?. Neurosurgery 1993; 33 (6) 999-1005 , discussion 1005–1006
• 16 Stienen MN, Smoll NR, Weisshaupt R , et al. Delayed cerebral ischemia predicts neurocognitive impairment following aneurysmal subarachnoid hemorrhage. World Neurosurg 2014; 82 (5) e599-e605
• 17 Mavaddat N, Sahakian BJ, Hutchinson PJ, Kirkpatrick PJ. Cognition following subarachnoid hemorrhage from anterior communicating artery aneurysm: relation to timing of surgery. J Neurosurg 1999; 91 (3) 402-407
• 18 Rodrigues AB, Yamashita ÉT, Chiappetta Ade ML. Teste de fluência verbal no adulto e no idoso: verificação da aprendizagem verbal. Rev CEFAC 2008; 10 (4) 443-451
• 19 Hütter BO, Gilsbach JM, Kreitschmann I. Quality of life and cognitive deficits after subarachnoid haemorrhage. Br J Neurosurg 1995; 9 (4) 465-475
• 20 Hadjivassiliou M, Tooth CL, Romanowski CA , et al. Aneurysmal SAH: cognitive outcome and structural damage after clipping or coiling. Neurology 2001; 56 (12) 1672-1677
• 21 Ogden JA, Mee EW, Henning M. A prospective study of impairment of cognition and memory and recovery after subarachnoid hemorrhage. Neurosurgery 1993; 33 (4) 572-586 , discussion 586–587
• 22 Frontera JA, Fernandez A, Schmidt JM , et al. Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition?. Stroke 2009; 40 (6) 1963-1968
• 23 Louko A-M, Vilkki J, Niskakangas T. ApoE genotype and cognition after subarachnoid haemorrhage: a longitudinal study. Acta Neurol Scand 2006; 114 (5) 315-319
• 24 Alfieri A, Unterhuber V, Pircher M , et al. Psychosocial and neurocognitive performance after spontaneous nonaneurysmal subarachnoid hemorrhage related to the APOE-epsilon4 genotype: a prospective 5-year follow-up study. J Neurosurg 2008; 109 (6) 1019-1026