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Current practice in neuropsychological outcome reporting after aneurysmal subarachnoid haemorrhage

  • Clinical Article - Vascular
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Abstract

Background

Neuropsychological deficits (NPD) are common in patients with aneurysmal subarachnoid haemorrhage (aSAH). NPD are one of the major limiting factors for patients with an otherwise acceptable prognosis for sustained quality of life. There are only a few studies reporting outcome after aSAH, which used a standardized neuropsychological test battery as a primary or secondary outcome measure. Aim of this study was to determine the current practice of reporting NPD following aSAH in clinical studies.

Methods

A MEDLINE analysis was performed using the search term “subarachnoid haemorrhage outcome”. The latest 1,000 articles were screened. We recorded study design, number of patients, and the presence of neuropsychological outcome report. Additionally, the time of testing after aSAH, the neuropsychological tests administered, as well as the percentage of patients with NPD were analyzed.

Results

A total of 324 publications between 2009 and 2012 were selected for further review. Of those, 21 studies (6.5%) reported neuropsychological outcome, in 2,001 of 346,666 patients (0.6%). The assessment of NPD differed broadly using both subjective and objective cognitive evaluation, and a large variety of tests were used.

Conclusion

Neuropsychological outcome is underreported, and there is great variety in assessment in currently published clinical articles on aSAH. Prospective randomized trials treating aSAH may benefit from implementing more comprehensive and standardized neuropsychological outcome measures. This approach might identify otherwise unnoticed treatment effects in future interventional studies of aSAH patients.

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References

  1. Ahola K, Vilkki J, Servo A (1996) Frontal tests do not detect frontal infarctions after ruptured intracranial aneurysm. Brain Cogn 31:1–16

    Article  PubMed  CAS  Google Scholar 

  2. Al-Khindi T, Macdonald RL, Schweizer TA (2010) Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. Stroke 41:e519–e536

    Article  PubMed  Google Scholar 

  3. Baisch SB, Schenk T, Noble AJ (2011) What is the cause of post-traumatic stress disorder following subarachnoid haemorrhage? Post-ictal events are key. Acta Neurochir (Wien) 153:913–922

    Article  Google Scholar 

  4. Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE Jr, Harbaugh RE, Patel AB, Rosenwasser RH, American Heart A (2009) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 40:994–1025

    Article  PubMed  Google Scholar 

  5. Bendel P, Koivisto T, Aikia M, Niskanen E, Kononen M, Hanninen T, Vanninen R (2010) Atrophic enlargement of CSF volume after subarachnoid hemorrhage: correlation with neuropsychological outcome. AJNR Am J Neuroradiol 31:370–376

    Article  PubMed  CAS  Google Scholar 

  6. Benke T, Koylu B, Delazer M, Trinka E, Kemmler G (2005) Cholinergic treatment of amnesia following basal forebrain lesion due to aneurysm rupture–an open-label pilot study. Eur J Neurol 12:791–796

    Article  PubMed  CAS  Google Scholar 

  7. Bjeljac M, Keller E, Regard M, Yonekawa Y (2002) Neurological and neuropsychological outcome after SAH. Acta Neurochir Suppl 82:83–85

    PubMed  CAS  Google Scholar 

  8. Boosman H, Passier PE, Visser-Meily JM, Rinkel GJ, Post MW (2010) Validation of the stroke specific quality of life scale in patients with aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 81:485–489

    Article  PubMed  Google Scholar 

  9. Chahal N, Barker-Collo S, Feigin V (2011) Cognitive and functional outcomes of 5-year subarachnoid haemorrhage survivors: comparison to matched healthy controls. Neuroepidemiology 37:31–38

    Article  PubMed  Google Scholar 

  10. Crago EA, Thampatty BP, Sherwood PR, Kuo CW, Bender C, Balzer J, Horowitz M, Poloyac SM (2011) Cerebrospinal fluid 20-HETE is associated with delayed cerebral ischemia and poor outcomes after aneurysmal subarachnoid hemorrhage. Stroke 42:1872–1877

    Article  PubMed  Google Scholar 

  11. Dorhout Mees SM, Rinkel GJ, Feigin VL, Algra A, van den Bergh WM, Vermeulen M, van Gijn J (2007) Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev:CD000277

  12. Escartin G, Junque C, Juncadella M, Gabarros A, de Miquel MA, Rubio F (2012) Decision-making impairment on the Iowa Gambling Task after endovascular coiling or neurosurgical clipping for ruptured anterior communicating artery aneurysm. Neuropsychology 26:172–180

    Article  PubMed  Google Scholar 

  13. Feigin VL, Lawes CM, Bennett DA, Anderson CS (2003) Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2:43–53

    Article  PubMed  Google Scholar 

  14. Fung C, Beck J, Lauber L, Muri R, Raabe A, Nyffeler T (2012) Clinical assessment of deficits after SAH: hasty neurosurgeons and accurate neurologists. J Neurol 259:2198–2201

    Article  PubMed  Google Scholar 

  15. Haug T, Sorteberg A, Finset A, Lindegaard KF, Lundar T, Sorteberg W (2010) Cognitive functioning and health-related quality of life 1 year after aneurysmal subarachnoid hemorrhage in preoperative comatose patients (Hunt and Hess Grade V patients). Neurosurgery 66:475–484, discussion 484–475

    Article  PubMed  Google Scholar 

  16. Hutter BO, Gilsbach JM (1993) Which neuropsychological deficits are hidden behind a good outcome (Glasgow = I) after aneurysmal subarachnoid hemorrhage? Neurosurgery 33:999–1005, discussion 1005–1006

    Article  PubMed  CAS  Google Scholar 

  17. Hutter BO, Gilsbach JM, Kreitschmann I (1995) Quality of life and cognitive deficits after subarachnoid haemorrhage. Br J Neurosurg 9:465–475

    Article  PubMed  CAS  Google Scholar 

  18. Hutter BO, Kreitschmann-Andermahr I, Gilsbach JM (1998) Cognitive deficits in the acute stage after subarachnoid hemorrhage. Neurosurgery 43:1054–1065

    Article  PubMed  CAS  Google Scholar 

  19. Hutter BO, Kreitschmann-Andermahr I, Mayfrank L, Rohde V, Spetzger U, Gilsbach JM (1999) Functional outcome after aneurysmal subarachnoid hemorrhage. Acta Neurochir Suppl 72:157–174

    PubMed  CAS  Google Scholar 

  20. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484

    Article  PubMed  CAS  Google Scholar 

  21. Jennett B, Snoek J, Bond MR, Brooks N (1981) Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 44:285–293

    Article  PubMed  CAS  Google Scholar 

  22. Johnston SC, Selvin S, Gress DR (1998) The burden, trends, and demographics of mortality from subarachnoid hemorrhage. Neurology 50:1413–1418

    Article  PubMed  CAS  Google Scholar 

  23. Kreiter KT, Copeland D, Bernardini GL, Bates JE, Peery S, Claassen J, Du YE, Stern Y, Connolly ES, Mayer SA (2002) Predictors of cognitive dysfunction after subarachnoid hemorrhage. Stroke 33:200–208

    Article  PubMed  Google Scholar 

  24. Kutlubaev MA, Barugh AJ, Mead GE (2012) Fatigue after subarachnoid haemorrhage: a systematic review. J Psychosom Res 72:305–310

    Article  PubMed  Google Scholar 

  25. Lammert A, Bode H, Hammes HP, Birck R, Fatar M, Zohsel K, Braun J, Schmieder K, Diepers M, Schubert GA, Barth M, Thome C, Seiz M (2011) Neuro-endocrine and neuropsychological outcome after aneurysmal subarachnoid hemorrhage (aSAH): a prospective cohort study. Exp Clin Endocrinol Diabetes 119:111–116

    Article  PubMed  CAS  Google Scholar 

  26. Latimer SF, Wilson FC, McCusker CG, Caldwell SB, Rennie I (2012) Subarachnoid haemorrhage (SAH): long-term cognitive outcome in patients treated with surgical clipping or endovascular coiling. Disabil Rehabil

  27. Ljunggren B, Sonesson B, Saveland H, Brandt L (1985) Cognitive impairment and adjustment in patients without neurological deficits after aneurysmal SAH and early operation. J Neurosurg 62:673–679

    Article  PubMed  CAS  Google Scholar 

  28. Macdonald RL, Cusimano MD, Etminan N, Hanggi D, Hasan D, Ilodigwe D, Jaja B, Lantigua H, Le Roux P, Lo B, Louffat-Olivares A, Mayer S, Molyneux A, Quinn A, Schweizer TA, Schenk T, Spears J, Todd M, Torner J, Vergouwen MD, Wong GK, Sahit C (2013) Subarachnoid Hemorrhage International Trialists Data Repository (SAHIT). World Neurosurg

  29. Macdonald RL, Hunsche E, Schuler R, Wlodarczyk J, Mayer SA (2012) Quality of life and healthcare resource use associated with angiographic vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 43:1082–1088

    Article  PubMed  Google Scholar 

  30. Mayer SA, Kreiter KT, Copeland D, Bernardini GL, Bates JE, Peery S, Claassen J, Du YE, Connolly ES Jr (2002) Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage. Neurology 59:1750–1758

    Article  PubMed  CAS  Google Scholar 

  31. Meyer B, Ringel F, Winter Y, Spottke A, Gharevi N, Dams J, Balzer-Geldsetzer M, Mueller IK, Klockgether T, Schramm J, Urbach H, Dodel R (2010) Health-related quality of life in patients with subarachnoid haemorrhage. Cerebrovasc Dis 30:423–431

    Article  PubMed  Google Scholar 

  32. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R, International Subarachnoid Aneurysm Trial Collaborative G (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274

    Article  PubMed  Google Scholar 

  33. Ogden JA, Mee EW, Henning M (1993) A prospective study of impairment of cognition and memory and recovery after subarachnoid hemorrhage. Neurosurgery 33:572–586, discussion 586–577

    Article  PubMed  CAS  Google Scholar 

  34. Passier PE, Post MW, van Zandvoort MJ, Rinkel GJ, Lindeman E, Visser-Meily JM (2011) Predicting fatigue 1 year after aneurysmal subarachnoid hemorrhage. J Neurol 258:1091–1097

    Article  PubMed  CAS  Google Scholar 

  35. Passier PE, Visser-Meily JM, Rinkel GJ, Lindeman E, Post MW (2011) Life satisfaction and return to work after aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 20:324–329

    Article  PubMed  Google Scholar 

  36. Passier PE, Visser-Meily JM, van Zandvoort MJ, Post MW, Rinkel GJ, van Heugten C (2010) Prevalence and determinants of cognitive complaints after aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis 29:557–563

    Article  PubMed  CAS  Google Scholar 

  37. Passier PE, Visser-Meily JM, van Zandvoort MJ, Rinkel GJ, Lindeman E, Post MW (2012) Predictors of long-term health-related quality of life in patients with aneurysmal subarachnoid hemorrhage. NeuroRehabilitation 30:137–145

    PubMed  CAS  Google Scholar 

  38. Pickard JD, Murray GD, Illingworth R, Shaw MD, Teasdale GM, Foy PM, Humphrey PR, Lang DA, Nelson R, Richards P (1989) Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ 298:636–642

    Article  PubMed  CAS  Google Scholar 

  39. Preiss M, Koblihova J, Netuka D, Bernardova L, Charvat F, Benes V (2012) Verbal memory capacity after treatment for ruptured intracranial aneurysm–the outcomes of three psychological tests: within a month, 1 year after and 5–7 years after treatment. Acta Neurochir (Wien) 154:417–422

    Article  Google Scholar 

  40. Preiss M, Netuka D, Koblihova J, Bernardova L, Charvat F, Kratochvilova D, Benes V (2012) Quality of life 1 year after aneurysmal subarachnoid hemorrhage in good outcome patients treated by clipping or coiling. J Neurol Surg A Cent Eur Neurosurg 73:217–223

    Article  PubMed  Google Scholar 

  41. Rankin J (1957) Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 2:200–215

    PubMed  CAS  Google Scholar 

  42. Santiago-Ramajo S, Katati MJ, Perez-Garcia M, Arjona-Moron V (2010) Evaluating the recovery of cognitive impairment in subarachnoid hemorrhage taking into consideration the practice effects. Neurosurgery 67:1497–1504, discussion 1504

    Article  PubMed  Google Scholar 

  43. Schatlo B, Fung C, Fathi AR, Sailer M, Winkler K, Daniel RT, Bijlenga P, Ahlborn P, Seule M, Zumofen D, Reinert M, Woernle C, Stienen M, Levivier M, Hildebrandt G, Mariani L, Bernays R, Fandino J, Raabe A, Keller E, Schaller K (2012) Introducing a nationwide registry: the Swiss study on aneurysmal subarachnoid haemorrhage (Swiss SOS). Acta Neurochir (Wien) 154:2173–2178, discussion 2178

    Article  Google Scholar 

  44. Schweizer TA, Al-Khindi T, Macdonald RL (2012) Mini-Mental State Examination versus Montreal Cognitive Assessment: rapid assessment tools for cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. J Neurol Sci 316:137–140

    Article  PubMed  Google Scholar 

  45. Springer MV, Schmidt JM, Wartenberg KE, Frontera JA, Badjatia N, Mayer SA (2009) Predictors of global cognitive impairment 1 year after subarachnoid hemorrhage. Neurosurgery 65:1043–1050, discussion 1050–1041

    Article  PubMed  Google Scholar 

  46. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607

    Article  PubMed  Google Scholar 

  47. Vilkki J, Holst P, Ohman J, Servo A, Heiskanen O (1990) Social outcome related to cognitive performance and computed tomographic findings after surgery for a ruptured intracranial aneurysm. Neurosurgery 26:579–584, discussion 584–575

    Article  PubMed  CAS  Google Scholar 

  48. Visser-Meily JM, Rhebergen ML, Rinkel GJ, van Zandvoort MJ, Post MW (2009) Long-term health-related quality of life after aneurysmal subarachnoid hemorrhage: relationship with psychological symptoms and personality characteristics. Stroke 40:1526–1529

    Article  PubMed  Google Scholar 

  49. Wong GK, Lam S, Ngai K, Wong A, Mok V, Poon WS, Cognitive Dysfunction after Aneurysmal Subarachnoid Haemorrhage I (2012) Evaluation of cognitive impairment by the Montreal cognitive assessment in patients with aneurysmal subarachnoid haemorrhage: prevalence, risk factors and correlations with 3 month outcomes. J Neurol Neurosurg Psychiatry 83:1112–1117

    Google Scholar 

  50. Wong GK, Wong R, Mok V, Wong A, Fan D, Leung G, Chan A, Poon WS (2009) Rivastigmine for cognitive impairment after spontaneous subarachnoid haemorrhage: a pilot study. J Clin Pharm Ther 34:657–663

    Article  PubMed  CAS  Google Scholar 

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Source of funding

There was no funding for this study.

Disclosures

None.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Switzerland

    Martin N. Stienen & Gerhard Hildebrandt

  2. Neuropsychology Unit, Department of Neurology, Kantonsspital Aarau, Switzerland

    Rahel Weisshaupt

  3. Department of Neurosurgery, Kantonsspital Aarau, Switzerland

    Javier Fandino & Bawarjan Schatlo

  4. Department of Neurosurgery, University Hospital Bern, Bern, Switzerland

    Christian Fung

  5. Neurointensive Care Unit, Department of Neurosurgery, University Hospital Zürich, Zürich, Switzerland

    Emanuela Keller

  6. Neuropsychology Unit, Department of Neurology, Kantonsspital, St. Gallen, Switzerland

    Aline Studerus-Germann

  7. Division of Cognitive and Restorative Neurology, Department of Neurology, University Hospital Bern, Bern, Switzerland

    Rene Müri & Klemens Gutbrod

  8. Department of Geriatrics, Memory Clinic, University Hospital Basel, Basel, Switzerland

    Stefan Bläsi & Andreas U. Monsch

  9. Neuropsychology Unit, Department of Neurology, University Hospital Zürich, Zürich, Switzerland

    Peter Brugger & Christian Mondadori

  10. Department of Neurosurgery, University Hospital Basel, Basel, Switzerland

    Martin Sailer

  11. Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland

    Philippe Bijlenga & Karl Schaller

Authors
  1. Martin N. Stienen
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  2. Rahel Weisshaupt
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  3. Javier Fandino
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  4. Christian Fung
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  5. Emanuela Keller
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  7. Aline Studerus-Germann
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  8. Rene Müri
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  9. Klemens Gutbrod
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  10. Stefan Bläsi
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  11. Andreas U. Monsch
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  12. Peter Brugger
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  13. Christian Mondadori
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  14. Martin Sailer
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  15. Philippe Bijlenga
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  16. Karl Schaller
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  17. Bawarjan Schatlo
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Consortia

on behalf of the Swiss SOS study group

Corresponding author

Correspondence to Martin N. Stienen.

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Comment

This is a well-written, thoughtfully constructed manuscript that will make a meaningful contribution to the literature and encourage cerebrovascular neurosurgeons and neurological critical care physicians who wish to improve outcomes in aneurysmal subarachnoid hemorrhage to incorporate neuropsychological testing into their routine post-operative rehabilitation regimens.

Christopher Loftus

Illinois, USA

Members and their affiliations are listed in the appendix

Appendix

Appendix

Further Swiss SOS contributors are listed below:

Ali-Reza Fathi - Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

Kerstin Winkler, Christoph Woernle, René Bernays - Department of Neurosurgery/Neurointensive Care Unit, University Hospital of Zurich, Zurich, Switzerland

Roy Thomas Daniel, Marc Levivier, Fabian Baumann - Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland

Peter Ahlborn, Martin Seule - Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland

Daniel Zumofen, Luigi Mariani, Michel Roethlisberger, Donato D’Alonzo - Department of Neurosurgery, Basel University Hospital, Basel, Switzerland

Andreas Raabe - Department of Neurosurgery (2a) Department of Intensive Care Medicine, Inselspital, Bern, Switzerland

Christian Chicherio - Department of Neurology, Neuropsychology Unit, University Hospital Geneva, Geneva, Switzerland

Michael Reinert - Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland

Leonardo Sacco - Department of Neurology, Neuropsychology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland

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Stienen, M.N., Weisshaupt, R., Fandino, J. et al. Current practice in neuropsychological outcome reporting after aneurysmal subarachnoid haemorrhage. Acta Neurochir 155, 2045–2051 (2013). https://doi.org/10.1007/s00701-013-1823-9

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