Neuropsychological profile and risk factors for poor cognitive outcomes in survivors of aneurysmal subarachnoid hemorrhage.

Abstract

Authors of this study aimed to characterize the neuropsychological profile of survivors of aneurysmal subarachnoid hemorrhage (aSAH) and identify clinical variables associated with poor cognitive outcomes. This retrospective observational study included patients with an aSAH diagnosis from 2009 to 2024. Cognitive outcomes were assessed at least 6 months after aSAH using the 22-item Montreal Cognitive Assessment (MoCA-22), Digit Span Test Forward (DST-F), Digit Span Test Backward (DST-B), and Verbal Fluency Test (VFT). Poor cognitive outcomes were defined as an MoCA-22 score < 25th percentile for population norms. Multivariable logistic regression was used to identify factors associated with poor cognitive outcomes. A subset of patients also completed the Beck Depression Inventory II, Stroke-Specific Quality of Life Scale, and Iowa Scales of Personality Change. A total of 156 patients were included. Fifty-three patients (34%) had an MoCA-22 score < 25th percentile, even though 79% of them had a modified Rankin Scale score ≤ 2 at discharge. Moderate and severe deficits (z-score < 1 SD) were observed in 11% of patients (17/156) on the DST-F, 27% (42/156) on the DST-B, and 9% (14/156) on the VFT. A modified Fisher grade 4 on admission (36/53, 68% vs 45/103, 44%) and infarction during hospitalization (16/53, 30% vs 11/103, 11%) were significantly associated with poor cognitive outcomes (adjusted odds ratio [aOR] 2.43, IQR 1.17-5.16, p = 0.018; and aOR 2.71, IQR 1.10-6.79, p = 0.029, respectively). Infarction also negatively impacted work productivity (OR 0.69, p = 0.015) and social relationships (OR 0.72, p = 0.029). Additionally, 27% of patients (12/44) reported at least mild depressive symptoms and 64% (29/45) acquired a personality disturbance. Survivors of aSAH can experience neuropsychological deficits, particularly those affecting executive function and working memory, despite good functional recovery. In this study, a modified Fisher grade 4 and new radiological infarction during hospitalization were associated with poor cognitive outcomes.