Predictors of Global Cognitive Impairment 1 Year After Subarachnoid Hemorrhage

Springer, Mellanie V.; Schmidt, J. Michael; Wartenberg, Katja E.; Frontera, Jennifer A.; Badjatia, Neeraj; Mayer, Stephan A.

doi:10.1227/01.neu.0000359317.15269.20

Cited by 123 publications

(77 citation statements)

References 35 publications

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“…43 A prospective cohort study from the US on cognitive status in 232 subarachnoid haemorrhage (SAH) survivors showed having ≤12 years education significantly increased the chance of cognitive impairment at 1 year after stroke (OR 7.2, P<0.001; 95% CI not reported). 44 In summary, there is some good-quality evidence that low SES is associated with more severe stroke and poorer functional status at up to one year after stroke. However, evidence on the relationship between SES and long-term functional outcomes is still lacking.…”

Section: Ses and Long-term Mortalitymentioning

confidence: 98%

The effects of socioeconomic status on stroke risk and outcomes

Marshall

Wang

Crichton

et al. 2015

The Lancet Neurology

310

218

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The latest international evidence on socio-economic status and stroke shows that stroke not only disproportionately affects low-and middle-income countries, but also socio-economically deprived populations within countries of all income categories. These disparities are found at every stage: from stroke prevention through acute care and rehabilitation, to long-term outcomes. Increased average levels of 'traditional' risk factors (hypertension, hyperlipidaemia, excess alcohol intake, smoking, obesity, sedentary lifestyle) in populations with lower SES appears to explain around half of the effect. In many countries there is evidence that people with lower SES are less likely to receive good quality acute hospital and rehabilitation care. For practice, better implementation of well-established treatments: traditional risk factor treatment and equity of access to high quality acute stroke care and rehabilitation seems likely to reduce inequality substantially. Overcoming barriers and adapting evidence-based interventions to different countries and healthcare settings remains a research priority.

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Section: Ses and Long-term Mortalitymentioning

confidence: 98%

The effects of socioeconomic status on stroke risk and outcomes

Marshall

Wang

Crichton

et al. 2015

The Lancet Neurology

310

218

View full text Add to dashboard Cite

show abstract

“…Although cognitive function tends to improve over the first year, 64 global cognitive impairment is still present in Ϸ20% of aSAH patients and is associated with poorer functional recovery and lower quality of life. 65 Cognitive deficits and functional decline are often compounded by mood disorders (anxiety, depression), fatigue, and sleep disturbances. 66 Therefore, scales assessing well-being and quality of life can be particularly useful in the integral assessment of patients with aSAH, even among those who regain functional independence.…”

Section: Natural History and Outcome Of Asahmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

2,957

1,375

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Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods— A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. Results— Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. Conclusions— aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.

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“…This might influence the assessment behavior of neurosurgeons shifting the focus away from cognitive deficits. It is only recently that papers have been published with more sophisticated outcome parameters including health-related quality of life, cognitive impairment, and emotional problems [2,6,7]. This reflects the growing interest and the meaning of cognitive impairment after SAH.…”

Section: Discussionmentioning

confidence: 99%

“…Up to 80 % of patients show a reduced health-related quality of life and deficits in neuropsychological functioning 1 year after SAH [2][3][4][5]. Cognitive impairment is one factor that greatly contributes to the reduction in quality of life for these patients [2,6].…”

Section: Introductionmentioning

confidence: 99%

Clinical assessment of deficits after SAH: hasty neurosurgeons and accurate neurologists

et al. 2012

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For survivors of aneurysmal subarachnoid hemorrhage (SAH), somatic and cognitive deficits can affect long-term outcomes. We were interested in comparing the deficits identified in SAH patients, including cognitive deficits, at discharge by neurosurgeons and deficits identified by neurologists upon admission to the rehabilitation unit on the same day. The assessment of deficits might have an impact on referring patients to rehabilitation. This retrospective study included 494 SAH patients treated between 2005 and 2010. Of these, 50 patients were discharged to an affiliated rehabilitation unit. Deficits were grouped into 18 categories and summarized into three groups: major somatic, minor somatic, and cognitive deficits. Major somatic deficits were identified in 16 and 20 patients (p = 0.53), minor somatic deficits in 16 and 44 (p \ 0.0001) patients, and cognitive deficits in 36 and 45 (p \ 0.04) patients by neurosurgeons and neurologists, respectively. The absolute number of deficits in daily activities identified by the neurosurgeon and neurologist were 21 and 31 major somatic deficits (p = 0.2), 18 and 97 minor somatic deficits (p \ 0.0001), and 61 and 147 cognitive deficits (p \ 0.0001), respectively. Significant differences in assessment of cognitive and minor somatic deficits between neurosurgeons and neurologists exist. Based on these findings, it is evident that for the neurosurgeon, there needs to be an increased awareness of the assessment of cognitive deficits and a more routine interdisciplinary approach, including the use of neuropsychological evaluations, to ensure a better triage of patients to rehabilitation or for discharge home.

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Predictors of Global Cognitive Impairment 1 Year After Subarachnoid Hemorrhage

Abstract: Global cognitive impairment affects more than 20% of subarachnoid hemorrhage survivors at 1 year, is predicted by fever, anemia treated with transfusion, and delayed cerebral ischemia, and adversely affects functional recovery and QOL.

Cited by 123 publications

References 35 publications

The effects of socioeconomic status on stroke risk and outcomes

The effects of socioeconomic status on stroke risk and outcomes

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Clinical assessment of deficits after SAH: hasty neurosurgeons and accurate neurologists

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