Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations

Zweifel-Zehnder, Antoinette; Stienen, Martin N.; Chicherio, Christian; Studerus-Germann, Aline; Bläsi, Stefan; Rossi, Stefania; Gutbrod, Klemens; Schmid, Nicole; Beaud, Valérie; Mondadori, Christian R.A.; Brugger, Peter; Sacco, Leonardo; Müri, René M.; Hildebrandt, Gerhard; Fournier, Jean–Yves; Keller, Emanuela; Regli, Luca; Fandiño, Javier; Mariani, Luigi; Raabe, Andreas; Daniel, Roy Thomas; Reinert, Michael; Robert, Thomas; Schatlo, Bawarjan; Schaller, Karl; Monsch, Andreas U.

doi:10.1007/s00701-015-2480-y

Cited by 33 publications

(20 citation statements)

References 75 publications

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“…One out of two of the whole SAH sample in this study presented with an officially certified degree of disability, and almost one out of three patients were incapacitated for work at follow-up which states the enormous socioeconomic importance of this certain subtype of stroke affecting preferentially people of younger ages. Our findings concerning long-term disability and occupational reintegration difficulties agree with the current state of scientific knowledge [36,51,60,70]. The HA+ patients revealed slightly higher, but non-significant levels of disability and unemployability.…”

Section: Discussionsupporting

confidence: 90%

The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis

et al. 2020

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Background Aneurysmal subarachnoid hemorrhage (SAH) as a serious type of stroke is frequently accompanied by a so-called initial thunderclap headache. However, the occurrence of burdensome long-term headache following SAH has never been studied in detail so far. The aim of this study was to determine the prevalence and characteristics of long-term burdensome headache in good-grade SAH patients as well as its relation to health-related quality of life (HR-QOL). Methods All SAH cases treated between January 2014 and December 2016 with preserved consciousness at hospital discharge were prospectively interviewed regarding burdensome headache in 2018. Study participants were subsequently scrutinized by means of a standardized postal survey comprising validated pain and HR-QOL questionnaires. A retrospective chart review provided data on the initial treatment. Results A total of 93 out of 145 eligible SAH patients participated in the study (62 females). A total of 41% (38/93) of subjects indicated burdensome headache at follow-up (mean 32.6 ± 9.3 months). Comparison between patients with (HA+) and without long-term headache (HA-) revealed significantly younger mean age (47.9 ± 11.8 vs. 55.6 ± 10.3 years; p < .01) as well as more favorable neurological conditions (WFNS I/II: 95% vs. 75%; p = .03) in HA+ cases. The mean average headache of the HA+ group was 3.7 ± 2.3 (10-point numeric rating scale), and the mean maximum headache intensity was 5.7 ± 2.9. Pain and HR-QOL scores demonstrated profound alterations in HA+ compared to HA-patients. Conclusions Our results suggest that a considerable proportion of SAH patients suffers from burdensome headache even years after the hemorrhage. Moreover, long-term headache is associated with reduced HR-QOL in these cases. Keywords Headache. Intracranial aneurysm. Quality of life. Subarachnoid hemorrhage This article is part of the Topical Collection on Vascular Neurosurgery-Aneurysm Previous presentation Parts of this study have been presented as an oral contribution at the 70th annual meeting of the German Society of Neurosurgery. The meeting was held in Würzburg (Germany) from May 12 to 15, 2019.

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Section: Discussionsupporting

confidence: 90%

The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis

et al. 2020

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“…These results were surprising, considering that up to 50% of stroke patients experience persistent cognitive sequelae following SAH [27-32]. Age is a contributing factor of poorer cognitive dysfunction following SAH, with significantly poorer outcomes after the age of 60 [33].…”

Section: Discussionmentioning

confidence: 90%

Determinants, Prevalence, and Trajectory of Long-Term Post-Stroke Cognitive Impairment: Results from a 4-Year Follow-Up of the ARCOS-IV Study

et al. 2017

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Background: The long-term (>12 months) prevalence, predictors, and trajectory of post-stroke cognitive deficits are not well established, especially at a community level. This study investigated the longitudinal course and prevalence of cognitive impairment in an incidence cohort, identifying factors associated with declining cognition. Methods: Two hundred fifty-seven participants (mean age = 67.93 ± 13.59) of first-ever stroke survivors, completed cognitive assessments within 2 weeks post stroke, and/or 1, 6, 12, and 48-month. Multivariate linear and logistic models were used to identify baseline predictors (reported as OR with 95% CI) and trajectory of cognitive impairment. Results: Cognitive functioning significantly declined by 2.8 points by 4 years post stroke. Eighty-four percent of stroke survivors had cognitive impairment indicative of post-stroke dementia (mean Montreal cognitive assessment = 20 ± 4.7) at 4-year. There were significant associations between progressive cognitive decline and the following factors: male gender (OR 2.9, 95% CI 1.6–5.9, p = 0.0171), coronary artery disease (OR 2.96, 95% CI 1.35–6.49, p = 0.0070), arrhythmia (OR 2.21, 95% CI 1.07–4.57, p = 0.0317), not in a relationship (OR 2.8, 95% CI 1.4–5.50, p < 0.0001), and not employed (OR 4.9, 95% CI 1.9–12.1, p < 0.0001). Conclusions: Cognitive deficits remain highly prevalent at 4-year post stroke. Early identification of those at higher risk of declining cognition is vital to target rehabilitation interventions at the acute stage and improve overall outcomes.

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“…Based on previous literature [14,19,20], the analysis focused on NPDs; the mRS, which is currently used as the "gold standard" for disability after a stroke, was used as a reference variable [21]. The mRS and Montreal Cognitive Assessment (MoCA) are both recommended by the National Institute of Health (NIH) and National Institute of Neurological Disorders and Stroke (NINDS) as valid outcome measures after aSAH (common data elements (CDE) working group on unruptured cerebral aneurysms and SAH [22]).…”

Section: Outcome Assessmentsmentioning

confidence: 99%

“…The MoCA-based evaluations were performed by neuropsychologists trained in its use, following the standard operating procedures for test conduction and scoring [25]. The MoCA is a well-studied, single-page screening tool for NPDs after aSAH that takes around 10-20 min to perform and uses a point-based system to evaluate patients' abilities of executive functions, naming, attention, recall, abstraction and orientation [14,19,26,27]. One additional point is added for patients with fewer than 12 years of education.…”

Section: Outcome Assessmentsmentioning

confidence: 99%

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Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage

et al. 2019

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Background Although most aneurysmal subarachnoid hemorrhage (aSAH) patients suffer from neuropsychological disabilities, outcome estimation is commonly based only on functional disability scales such as the modified Rankin Scale (mRS). Moreover, early neuropsychological screening tools are not used routinely. Objective To study whether two simple neuropsychological screening tools identify neuropsychological deficits (NPDs), among aSAH patients categorized with favorable outcome (mRS 0-2) at discharge. Methods We reviewed 170 consecutive aSAH patients that were registered in a prospective institutional database. We included all patients graded by the mRS at discharge, and who had additionally been evaluated by a neuropsychologist and/or occupational therapist using the Montreal Cognitive Assessment (MoCA) and/or Rapid Evaluation of Cognitive Function (ERFC). The proportion of patients with scores indicative of NPDs in each test were reported, and spearman correlation tests calculated the coefficients between the both neuropsychological test results and the mRS. Results Of the 42 patients (24.7%) that were evaluated by at least one neuropsychological test, 34 (81.0%) were rated mRS 0-2 at discharge. Among these 34 patients, NPDs were identified in 14 (53.9%) according to the MoCA and 8 (66.7%) according to the ERFC. The mRS score was not correlated with the performance in the MoCA or ERFC. Conclusion The two screening tools implemented here frequently identified NPDs among aSAH patients that were categorized with favorable outcome according to the mRS. Our results suggest that MoCA or ERFC could be used to screen early NPDs in favorable outcome patients, who in turn might benefit from early neuropsychological rehabilitation.

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Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations

Cited by 33 publications

References 75 publications

The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis

The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis

Determinants, Prevalence, and Trajectory of Long-Term Post-Stroke Cognitive Impairment: Results from a 4-Year Follow-Up of the ARCOS-IV Study

Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage

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