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Clinical study on cognitive dysfunction after spontaneous subarachnoid haemorrhage: patient profiles and relationship to cholinergic dysfunction

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Abstract

Purpose

We aimed to explore the cognitive profiles of subarachnoid haemorrhage patients who returned to the community, along with the associated risk factors.

Methods

We recruited 40 Chinese patients with spontaneous subarachnoid haemorrhage 7–27 months after the initial presentation. They had all been discharged to their homes or to care homes for the elderly. For cognitive assessment, we employed the Cognitive Subscale of the Alzheimer Disease Assessment Scale (ADAS-cog) for global cognitive function, the Frontal Assessment Battery (FAB) for frontal lobe function, and the Rivermead Behavioural Memory Test (RBMT) for everyday memory function.

Results

An ADAS-cog of more than 21/85 (poor global cognitive function) was noted in 14 (35%) patients. A FAB of less than 12/18 (poor frontal lobe function) was noted in 13 (27.5%) patients. An RBMT score of less than 15/26 (poor everyday memory function) was noted in 17 (43.6%) patients. Poor cognitive function was found to be associated with chronic hydrocephalus (in terms of FAB), with clinical vasospasm (in terms of RBMT), and with cerebral infarction (in terms of RBMT).

Conclusions

Poor cognitive function was common and occurred in up to 43.6% of the patients, with the verbal and behavioural memory aspects predominantly affected. We did not find a significant association between cholinergic dysfunction and cognitive dysfunction. Organization of future drug trials and cognitive rehabilitation should take into account the association between frontal lobe dysfunction and chronic hydrocephalus.

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References

  1. Barker-Collo S, Feign V (2006) The impact of neuropsychological deficits on functional stroke. Neuropsychol Rev 16:53–64. doi:10.1007/s11065-006-9007-5

    Article  PubMed  Google Scholar 

  2. Chan A, Ho S, Poon WS (2002) Neuropsychological sequalae of patients treated with microsurgical clipping or endovascular embolization for anterior communicating artery aneurysm. Eur Neurol 47(1):37–44. doi:10.1159/000047945

    Article  PubMed  Google Scholar 

  3. Clare L, Wilson BA, Emsile H, Tate R, Watson P (2000) Adapting the Rivermead Behavioural Memory Test Extended Version (RBMT-E) for people with restricted mobility. Br J Clin Psychol 39:363–369. doi:10.1348/014466500163365

    Article  PubMed  Google Scholar 

  4. Chu LW, Chiu KC, Hui SL, Yu GK, Tsui WJ, Lee PW (2000) The reliability and validity of the Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS-Cog) among the elderly Chinese in Hong Kong. Ann Acad Med Singapore 29:474–485

    CAS  PubMed  Google Scholar 

  5. Dubois B, Slachevsky A, Litvan I, Pillon B (2000) The FAB: A frontal assessment battery at bedside. Neurology 55:1621–1626

    CAS  PubMed  Google Scholar 

  6. Egge A, Waterloo K, Sjoholm H, Ingebrigtsen T, Forsdahl S, Jacobsen EA, Romner B (2005) Outcome 1 year after aneurysmal subarachnoid hemorrhage: relation between cognitive performance and neuroimaging. Acta Neurol Scand 112:76–80. doi:10.1111/j.1600-0404.2005.00449.x

    Article  CAS  PubMed  Google Scholar 

  7. Fontanella M, Perozzo P, Ursone R, Garbossa D, Bergui M (2003) Neuropsychological assessment after microsurgical clipping or endovascular treatment for anterior communicating artery aneurysm. Acta Neurochir (Wien) 145:867–872. doi:10.1007/s00701-003-0111-5

    Article  CAS  Google Scholar 

  8. Frazer D, Ahuja A, Watkins L, Cipolotti L (2007) Coiling versus clipping for the treatment of aneurysmal subarachnoid haemorrhage: a longitudinal investigation into cognitive outcome. Neurosurgery 60:434–442. doi:10.1227/01.NEU.0000255335.72662.25

    Article  PubMed  Google Scholar 

  9. Hackett ML, Anderson CS, Australian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS) Group (2000) Health outcome 1 year after subarachnoid hemorrhage: an international population-based study. Neurology 55:658–662

    Google Scholar 

  10. Kazui H, Matsuda A, Hirono N, Mori E, Miyoshi N, Ogino A, Tokunaga H, Ikejiri Y, Takeda M (2005) Everyday memory impairment of patients with mild cognitive impairment. Dement Geriatr Cogn Disord 19:331–337. doi:10.1159/000084559

    Article  PubMed  Google Scholar 

  11. King JT, DiLuna ML, Cicchetti DV, Tsevat J, Roberts MS (2006) Cognitive functioning in patients with cerebral aneurysms measured with the mini mental state examination and the telephone interview for cognitive status. Neurosurgery 59:803–811. doi:10.1227/01.NEU.0000232666.67779.41

    Article  PubMed  Google Scholar 

  12. Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi J, Vapalahti M (2000) Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms: a prospective randomized study. Stroke 31:2369–2377

    CAS  PubMed  Google Scholar 

  13. Kurz S, Krummenauer F, Pfeiffer N, Dick HB (2004) Monocular versus binocular pupillometry. J Cataract Refract Surg 30:2551–2556. doi:10.1016/j.jcrs.2004.05.025

    Article  PubMed  Google Scholar 

  14. Mayer SA, Kreiter KT, Bernardini GL, Bates JE, Peery S, Claassen J, Du YE, Connolly ES (2002) Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage. Neurology 59:1750–1758. doi:10.1001/archneur.59.11.1750

    Article  CAS  PubMed  Google Scholar 

  15. Mok VC, Wong A, Yim P, Fu M, Lam WW, Hui AC, Yau C, Wong KS (2004) The validity and reliability of Chinese Frontal Assessment Battery in evaluating executive dysfunction among Chinese patients with small subcortical infarct. Alzheimer Dis Assoc Disord 18:68–74. doi:10.1097/01.wad.0000126617.54783.7

    Article  PubMed  Google Scholar 

  16. Naidech AM, Kreiter KT, Janjua N, Ostapkovich N, Parra A, Commichau C, Connolly ES, Mayer SA, Fitzsimmons BM (2005) Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage. Stroke 36:583–587. doi:10.1161/01.STR.0000141936.36596.1e

    Article  CAS  PubMed  Google Scholar 

  17. Ng B, Fong K, Wong R, Lau A, Lee C, Lau G, Ho A, Cheung P, Au J, Ho R, Man D (1998) Validation of the Rivermead Behavioural Memory Test- Cantonese Version. Hong Kong J Occup Ther 9(1):18–24

    Google Scholar 

  18. Perneczky R, Pohl C, Sorg C, Hartmann J, Komossa K, Alexopoulos P, Wagenpfeil S, Kurz A (2006) Complex activities of daily living in mild cognitive impairment: conceptual and diagnostic issues. Age Ageing 35:240–245. doi:10.1093/ageing/afj054

    Article  PubMed  Google Scholar 

  19. Powell J, Kitchen N, Heslin J, Greenwood R (2004) Psychosocial outcomes at 18 months after good neurological recovery from aneurysmal subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry 75:1119–1124. doi:10.1136/jnnp. 2002.000414

    Article  CAS  PubMed  Google Scholar 

  20. Samra SK, Giordani B, Caveney AF, Clarke WR, Scott PA, Anderson S, Thompson BG, Todd MM (2007) Recovery of cognitive function after surgery for aneurismal subarachnoid hemorrhage. Stroke 38:1864–1872. doi:10.1161/STROKEAHA.106.477448

    Article  PubMed  Google Scholar 

  21. Silver JM, Koumaras B, Chen M, Mirski D, Potkin SG, Reyes P, Warden D, Harvey PD, Arciniegas D, Katz DI, Gunay I (2006) Effects of rivastigmine on cognitive function in patients with traumatic brain injury. Neurology 67:748–755. doi:10.1212/01.wnl.0000234062.98062.e9

    Article  CAS  PubMed  Google Scholar 

  22. Stenhouse LM, Knight RG, Longmore BE, Nishara SN (1991) Long-term cognitive deficits in patients after surgery on aneurysms of the anterior communicating artery. J Neurol Neurosurg Psychiatry 54:909–914. doi:10.1136/jnnp. 54.10.909

    Article  CAS  PubMed  Google Scholar 

  23. Takao N, Naoto S, Haruyuki O, Shigeru N, Hiroki N (2002) Cholinergic dysfunction in cognitive impairments after aneurysmal subarachnoid hemorrhage. Neurosurgery 51:944–948. doi:10.1097/00006123-200210000-00016

    Article  Google Scholar 

  24. Tidswell P, Dias PS, Sagar HJ, Mayes AR, Battersby RD (1995) Cognitive outcome after aneurysm rupture: relationship to aneurysm site and perioperative complications. Neurology 45:875–882

    CAS  PubMed  Google Scholar 

  25. Vilkki JS, Juvela S, Siironen J, Ilvonen T, Varis J, Porras M (2004) Relationship of local infarctions to cognitive and psychosocial impairments after aneurysmal subarachnoid hemorrhage. Neurosurgery 55:790–803. doi:10.1227/01.NEU.0000137629.17424.6D

    Article  PubMed  Google Scholar 

  26. Wang H, Yu X, Li S, Chen Y, He J (2004) The cognitive subscale of Alzheimer’s Disease Assessment Scale, Chinese version in staging of Alzheimer disease. Alzheimer Dis Assoc Disord 18:231–235. doi:10.1097/01.wad.0000137521.61487.68

    Article  PubMed  Google Scholar 

  27. Yu SC, Wong GK, Wong JK, Poon WS (2007) Endovascular coiling versus neurosurgical clipping for ruptured intracranial aneurysms: significant benefits in clinical outcome and reduced consumption of hospital resources in Hong Kong Chinese patients. Hong Kong Med J 13:271–278

    PubMed  Google Scholar 

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Acknowledgements

This study was supported by Direct Grant for Research CUHK 2005/2006 (reference no.: 2005.2.046), The Chinese University of Hong Kong, Hong Kong. We were grateful for the input on statistical issues from Dr. Stephanie CP Ng, Scientific Officer CUHK.

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Authors and Affiliations

  1. Division of Neurosurgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong

    George K. C. Wong, Cannon X. L. Zhu & Wai S. Poon

  2. Department of Occupational Therapy, The Chinese University of Hong Kong, Hong Kong, Hong Kong

    Rosanna Wong

  3. Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong, Hong Kong

    Dorothy S. P. Fan & Gloria Leung

  4. Division of Neurology, The Chinese University of Hong Kong, Hong Kong, Hong Kong

    Vincent C. T. Mok & Adrian Wong

  5. Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong

    Agnes S. Y. Chan

  6. Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China

    Wai S. Poon

Authors
  1. George K. C. Wong
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  2. Rosanna Wong
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  3. Vincent C. T. Mok
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  4. Dorothy S. P. Fan
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  5. Gloria Leung
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  6. Adrian Wong
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  7. Agnes S. Y. Chan
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  8. Cannon X. L. Zhu
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  9. Wai S. Poon
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Corresponding author

Correspondence to Wai S. Poon.

Additional information

Comment

The issue of cognitive performance after subarachnoid haemorrhage is important, and the study adds to the information available on the topic. The study has been carefully conducted on a homogeneous group of patients treated in the same centre. The cognitive tests chosen show some ceiling effects, and a matched control group would allow more precise interpretation of the findings. Nonetheless, the study indicates that cognitive impairment is common, and this should serve to stimulate further work on this topic.

Lindsay Wilson

Stirling University, UK

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Wong, G.K.C., Wong, R., Mok, V.C.T. et al. Clinical study on cognitive dysfunction after spontaneous subarachnoid haemorrhage: patient profiles and relationship to cholinergic dysfunction. Acta Neurochir 151, 1601–1607 (2009). https://doi.org/10.1007/s00701-009-0425-z

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  • DOI: https://doi.org/10.1007/s00701-009-0425-z

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