Cognitive function, depression, and quality of life in patients with ruptured cerebral aneurysms
Background: Neuropsychiatric dysfunction is one of the most common complications after aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study was to evaluate cognitive function, depression, and quality of life (QOL) in patients with aSAH.
Methods: In this study, we prospectively enrolled patients with SAH due to rupture of anterior circulation aneurysms who referred to Ghaem hospital, Mashhad, Iran, and who had good function outcome [modified Rankin scale (mRS) > 2]. They underwent microsurgery or endovascular treatment. Cognitive function, depression, and QOL were evaluated 6 months after surgery with standard psychiatric examinations, including Mini-Mental State Examination (MMSE) for cognitive function, Hospital Anxiety and Depression Scale (HADS) for depression, and 36-Item Short Form Health Survey (SF-36) for QOL. Risk factors for cognitive dysfunction were assessed.
Results: Fifty-three patients were entered the study. The mean of age was 50.9 ± 13.6 years. QOL and its components were affected in most patients. Fifty-five percent of patients suffered from depression. Cognitive impairment was found in 57% of patients. Older patients experienced more cognitive impairment (P < 0.001).
Conclusion: Neuropsychological sequels are common in patients with aSAH, even if they classified as good functional outcome (mRS > 2). These complications could be found with appropriate neuropsychological evaluation of these patients to be managed as soon as possible.
2. Hackett ML, Anderson CS. Health outcomes 1 year after subarachnoid hemorrhage: An international population-based study. The Australian cooperative research on subarachnoid hemorrhage study group. Neurology 2000; 55(5): 658-62.
3. Mayer SA, Kreiter KT, Copeland D, Bernardini GL, Bates JE, Peery S, et al. Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage. Neurology 2002; 59(11): 1750-8.
4. Hutter BO, Gilsbach JM. Which neuropsychological deficits are hidden behind a good outcome (Glasgow = I) after aneurysmal subarachnoid hemorrhage? Neurosurgery 1993; 33(6): 999-1005.
5. Hutter BO, Gilsbach JM, Kreitschmann I. Quality of life and cognitive deficits after subarachnoid haemorrhage. Br J Neurosurg 1995; 9(4): 465-75.
6. Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med 2006; 355(9): 928-39.
7. Tjahjadi M, Heinen C, Konig R, Rickels E, Wirtz CR, Woischneck D, et al. Health-related quality of life after spontaneous subarachnoid hemorrhage measured in a recent patient population. World Neurosurg 2013; 79(2): 296-307.
8. Cronqvist M, Wirestam R, Ramgren B, Brandt L, Nilsson O, Saveland H, et al. Diffusion and perfusion MRI in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: Complications, procedural results, MR findings and clinical outcome. Neuroradiology 2005; 47(11): 855-73.
9. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The short form health survey (SF-36): Translation and validation study of the Iranian version. Qual Life Res 2005; 14(3): 875-82.
10. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-98.
11. Noble AJ, Schenk T. Which variables help explain the poor health-related quality of life after subarachnoid hemorrhage? A meta-analysis. Neurosurgery 2010; 66(4): 772-83.
12. Hutter BO, Kreitschmann-Andermahr I, Gilsbach JM. Health-related quality of life after aneurysmal subarachnoid hemorrhage: Impacts of bleeding severity, computerized tomography findings, surgery, vasospasm, and neurological grade. J Neurosurg 2001; 94(2): 241-51.
13. Hop JW, Rinkel GJ, Algra A, van Gijn J. Quality of life in patients and partners after aneurysmal subarachnoid hemorrhage. Stroke 1998; 29(4): 798-804.
14. Wong GK, Poon WS, Boet R, Chan MT, Gin T, Ng SC, et al. Health-related quality of life after aneurysmal subarachnoid hemorrhage: Profile and clinical factors. Neurosurgery 2011; 68(6): 1556-61.
15. Kreitschmann-Andermahr I, Poll E, Hutter BO, Reineke A, Kristes S, Gilsbach JM, et al. Quality of life and psychiatric sequelae following aneurysmal subarachnoid haemorrhage: Does neuroendocrine dysfunction play a role? Clin Endocrinol (Oxf) 2007; 66(6): 833-7.
16. Greebe P, Rinkel GJ, Hop JW, Visser-Meily JM, Algra A. Functional outcome and quality of life 5 and 12.5 years after aneurysmal subarachnoid haemorrhage. J Neurol 2010; 257(12): 2059-64.
17. Sonesson B, Kronvall E, Saveland H, Brandt L, Nilsson OG. Long-term reintegration and quality of life in patients with subarachnoid hemorrhage and a good neurological outcome: Findings after more than 20 years. J Neurosurg 2018; 128(3): 785-92.
18. Hutter BO, Kreitschmann-Andermahr I, Mayfrank L, Rohde V, Spetzger U, Gilsbach JM. Functional outcome after aneurysmal subarachnoid hemorrhage. Acta Neurochir Suppl 1999; 72: 157-74.
19. Katati MJ, Santiago-Ramajo S, Perez-Garcia M, Meersmans-Sanchez Jofre M, Vilar-Lopez R, Coin-Mejias MA, et al. Description of quality of life and its predictors in patients with aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis 2007; 24(1): 66-73.
20. Soehle M, Chatfield DA, Czosnyka M, Kirkpatrick PJ. Predictive value of initial clinical status, intracranial pressure and transcranial Doppler pulsatility after subarachnoid haemorrhage. Acta Neurochir (Wien) 2007; 149(6): 575-83.
21. Hop JW, Rinkel GJ, Algra A, van Gijn J. Changes in functional outcome and quality of life in patients and caregivers after aneurysmal subarachnoid hemorrhage. J Neurosurg 2001; 95(6): 957-63.
22. Scott RB, Eccles F, Lloyd A, Carpenter K. From multidimensional neuropsychological outcomes to a cognitive complication rate: The International Subarachnoid Aneurysm Trial. Trials 2008; 9: 13.
23. Jonsson AC, Lindgren I, Hallstrom B, Norrving B, Lindgren A. Determinants of quality of life in stroke survivors and their informal caregivers. Stroke 2005; 36(4): 803-8.
24. Haug T, Sorteberg A, Sorteberg W, Lindegaard KF, Lundar T, Finset A. Cognitive functioning and health related quality of life after rupture of an aneurysm on the anterior communicating artery versus middle cerebral artery. Br J Neurosurg 2009; 23(5): 507-15.
25. Berry E. Post-traumatic stress disorder after subarachnoid haemorrhage. Br J Clin Psychol 1998; 37 (Pt 3): 365-7.
26. Powell J, Kitchen N, Heslin J, Greenwood R. Psychosocial outcomes at three and nine months after good neurological recovery from aneurysmal subarachnoid haemorrhage: Predictors and prognosis. J Neurol Neurosurg Psychiatry 2002; 72(6): 772-81.
27. Powell J, Kitchen N, Heslin J, Greenwood R. Psychosocial outcomes at 18 months after good neurological
recovery from aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2004; 75(8): 1119-24.
28. Beristain X, Gaviria M, Dujovny M, Abd el-Bary TH, Stark JL, Ausman JI. Evaluation of outcome after intracranial aneurysm surgery: The neuropsychiatric approach. Surg Neurol 1996; 45(5): 422-8.
29. Noble AJ, Baisch S, Mendelow AD, Allen L, Kane P, Schenk T. Posttraumatic stress disorder explains reduced quality of life in subarachnoid hemorrhage patients in both the short and long term. Neurosurgery 2008; 63(6): 1095-104.
30. Hutter BO, Kreitschmann-Andermahr I. Subarachnoid hemorrhage as a psychological trauma. J Neurosurg 2014; 120(4): 923-30.
31. Noble AJ, Schenk T. Psychological distress after subarachnoid hemorrhage: Patient support groups can help us better detect it. J Neurol Sci 2014; 343(1-2): 125-31.
32. Hedlund M, Zetterling M, Ronne-Engstrom E, Carlsson M, Ekselius L. Depression and post-traumatic stress disorder after aneurysmal subarachnoid haemorrhage in relation to lifetime psychiatric morbidity. Br J Neurosurg 2011; 25(6): 693-700.
33. King JT Jr, DiLuna ML, Cicchetti DV, Tsevat J, Roberts MS. Cognitive functioning in patients with cerebral aneurysms measured with the mini mental state examination and the telephone interview for cognitive status. Neurosurgery 2006; 59(4): 803-10.
34. Wong GK, Lam SW, Wong A, Ngai K, Poon WS, Mok V. Comparison of montreal cognitive assessment and mini-mental state examination in evaluating cognitive domain deficit following aneurysmal subarachnoid haemorrhage. PLoS One 2013; 8(4): e59946.
35. Saciri BM, Kos N. Aneurysmal subarachnoid haemorrhage: Outcomes of early rehabilitation after surgical repair of ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 2002; 72(3): 334-7.
36. Kreiter KT, Copeland D, Bernardini GL, Bates JE, Peery S, Claassen J, et al. Predictors of cognitive dysfunction after subarachnoid hemorrhage. Stroke 2002; 33(1): 200-8.
37. Hadjivassiliou M, Tooth CL, Romanowski CA, Byrne J, Battersby RD, Oxbury S, et al. Aneurysmal SAH: Cognitive outcome and structural damage after clipping or coiling. Neurology 2001; 56(12): 1672-7.
38. Egeto P, Loch Macdonald R, Ornstein TJ, Schweizer TA. Neuropsychological function after endovascular and neurosurgical treatment of subarachnoid hemorrhage: A systematic review and meta-analysis. J Neurosurg 2018; 128(3): 768-76.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.