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Research paper
Cognitive domain deficits in patients with aneurysmal subarachnoid haemorrhage at 1 year
  1. George Kwok Chu Wong1,
  2. Sandy Wai Lam1,
  3. Karine Ngai1,
  4. Adrian Wong2,
  5. Deyond Siu3,
  6. Wai Sang Poon1,
  7. Vincent Mok2,
  8. Cognitive Dysfunction after Aneurysmal Subarachnoid Hemorrhage Investigators
  1. 1Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
  2. 2Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
  3. 3Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
  4. 4Department of Psychological Studies, The Hong Kong Institute of Education, Tai Po, New Territories, Hong Kong
  1. Correspondence to Dr George Kwok Chu Wong, Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 4/F Clinical Science Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong; georgewong{at}surgery.cuhk.edu.hk

Abstract

Background Cognitive domain deficits can occur after aneurysmal subarachnoid haemorrhage (aSAH) though few studies systemically evaluate its impact on 1-year outcomes.

Objective We aimed to evaluate the pattern and functional outcome impact of cognitive domain deficits in aSAH patients at 1 year.

Methods We carried out a prospective observational study in Hong Kong, during which, 168 aSAH patients (aged 21–75 years and had been admitted within 96 h of ictus) were recruited over a 26-month period. The cognitive function was assessed by a domain-specific neuropsychological assessment battery at 1 year after ictus. The current study is registered at ClinicalTrials.gov of the US National Institutes of Health (NCT01038193).

Results Prevalence of individual domain deficits varied between 7% to 15%, and 13% had two or more domain deficits. After adjusting for abbreviated National Institute of Health Stroke Scale and Geriatric Depressive Scale scores, unfavourable outcome (Modified Rankin Scale 3–5) and dependent instrumental activity of daily living (Lawton Instrumental Activity of Daily Living<15) were significantly associated with two or more domain deficits and number of cognitive domain deficits at 1 year. Two or more domain deficits was independently associated with age (OR, 1.1; 95% CI 1.1 to 1.2; p<0.001) and delayed cerebral infarction (OR, 6.1; 95% CI 1.1 to 33.5; p=0.036), after adjustment for years of school education.

Interpretation In patients with aSAH, cognitive domain deficits worsened functional outcomes at 1 year. Delayed cerebral infarction was an independent risk factor for two or more domain deficits at 1 year.

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