Advertisement

Long-Term Cognitive Outcome following Aneurysmal Subarachnoid Haemorrhage

      Highlights

      • Subarachnoid haemorrhage impacts cognition and employment status.
      • Reaction time slowing has a discernible impact on employment status.
      • Reaction time and employment can be used as outcomes after subarachnoid haemorrhage in the UK Biobank.

      Abstract

      Objectives

      Survivors of aneurysmal subarachnoid haemorrhage (aSAH) frequently suffer from cognitive dysfunction. The aim of this study was to assess, in a large sample size with long term follow-up, the characteristics of cognitive dysfunction following aSAH and explore whether cognitive deficits mediate employment outcome.

      Materials and methods

      In this retrospective case-controlled study, aSAH survivors (n = 884) were identified from the UK Biobank and compared to matched controls (n = 3536). Controls were propensity score matched according to age, sex, Townsend deprivation score, educational status and relevant medications known to influence cognition. Cognitive outcomes and employment status were compared between cases and controls using group comparison and cross-tabulation tests. A regression-based mediation analysis was performed to assess whether cognitive deficits mediate employment status following aSAH.

      Results

      Psychomotor reaction time and employment status significantly differed between aSAH cases and controls with slower reaction times (p < 0.001) and more unemployment or inability to work due to illness (p < 0.001) in the aSAH cohort at a mean follow-up of 125 months. Psychomotor slowing was estimated to mediate a significant proportion (6.59%) of the effect of aSAH on employment status.

      Conclusions

      Psychomotor reaction time and employment status differed significantly between aSAH cases and control matched individuals in the UK Biobank. Psychomotor slowing following aSAH had a discernible impact on employment status. Psychomotor reaction time and employment status are practical to acquire and can be used as surrogate measures of outcome in future studies of aSAH survivors.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Al-Khindi T.
        • Macdonald R.L.
        • Schweizer T.A.
        Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage.
        Stroke. 2010; 41 (2010/07/01): e519-e536https://doi.org/10.1161/STROKEAHA.110.581975
        • Nussbaum E.S.
        • Mikoff N.
        • Paranjape G.S.
        Cognitive deficits among patients surviving aneurysmal subarachnoid hemorrhage. A contemporary systematic review.
        Br J Neurosurg. 2020; (20201221): 1-18https://doi.org/10.1080/02688697.2020.1859462
        • Pace A.
        • Mitchell S.
        • Casselden E.
        • et al.
        A subarachnoid haemorrhage-specific outcome tool.
        Brain. 2018; (2018/02/01)https://doi.org/10.1093/brain/awy003
        • Farrell B.
        • Godwin J.
        • Richards S.
        • et al.
        The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results.
        J Neurol Neurosurg Psychiatry. 1991; 54: 1044-1054
        • Jennett B.
        • Bond M.
        Assessment of outcome after severe brain damage.
        Lancet. 1975; 1: 480-484
        • Kreiter K.T.
        • Copeland D.
        • Bernardini G.L.
        • et al.
        Predictors of cognitive dysfunction after subarachnoid hemorrhage.
        Stroke. 2002; 33: 200-208https://doi.org/10.1161/hs0102.101080
        • Quinn A.C.
        • Bhargava D.
        • Al-Tamimi Y.Z.
        • et al.
        Self-perceived health status following aneurysmal subarachnoid haemorrhage: a cohort study.
        BMJ Open. 2014; 4 (2014/04/03)e003932https://doi.org/10.1136/bmjopen-2013-003932
        • Passier P.E.
        • Visser-Meily J.M.
        • Rinkel G.J.
        • et al.
        Life satisfaction and return to work after aneurysmal subarachnoid hemorrhage.
        J Stroke Cerebrovasc Dis. 2011; 20 (20100724): 324-329https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.02.001
        • Passier P.E.
        • Visser-Meily J.M.
        • van Zandvoort M.J.
        • et al.
        Prevalence and determinants of cognitive complaints after aneurysmal subarachnoid hemorrhage.
        Cerebrovasc Dis. 2010; 29 (20100408): 557-563https://doi.org/10.1159/000306642
        • Sudlow C.
        • Gallacher J.
        • Allen N.
        • et al.
        UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age.
        PLoS Med. 2015; 12 (2015/03/31)e1001779https://doi.org/10.1371/journal.pmed.1001779
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008; 61: 344-349https://doi.org/10.1016/j.jclinepi.2007.11.008
        • Cullen B.
        • Smith D.J.
        • Deary I.J.
        • et al.
        The cognitive footprint' of psychiatric and neurological conditions: cross-sectional study in the UK Biobank cohort.
        Acta Psychiatr Scand. 2017; 135 (2017/04/07): 593-605https://doi.org/10.1111/acps.12733
      1. (by)
        • Mackenbach J.P.
        • Townsend P.
        • Phillimore P.
        • Beattie A.
        Health and deprivation: inequality and the North. 10. Croom Helm Ltd., London1988: 206-207 (byeds.1987 221 pp., ISBN 0-7099-4352-0, [pound sign]8.95Health Policy)
        • Nevado-Holgado A.J.
        • Kim C.H.
        • Winchester L.
        • et al.
        Commonly prescribed drugs associate with cognitive function: a cross-sectional study in UK Biobank.
        BMJ Open. 2016; 6 (2016/11/30)e012177https://doi.org/10.1136/bmjopen-2016-012177
        • Hayes A.F.
        Introduction to mediation, moderation, and conditional process analysis: a regression-based approach.
        2nd ed. Guilford Press, New York, USA2018 (ISBN 9781462534654)
        • VanderWeele T.J.
        Mediation analysis: a practitioner's guide.
        Annu Rev Public Health. 2016; 37 (2015/11/30): 17-32https://doi.org/10.1146/annurev-publhealth-032315-021402
        • Hütter B.O.
        • Gilsbach J.M.
        • Kreitschmann I.
        Quality of life and cognitive deficits after subarachnoid haemorrhage.
        Br J Neurosurg. 1995; 9: 465-475https://doi.org/10.1080/02688699550041106
        • da Costa L.
        • Shah-Basak P.P.
        • Dunkley B.T.
        • et al.
        Visual working memory encoding and recognition in good outcome aneurysmal subarachnoid patients.
        Front Neurol. 2018; 9 (20180626): 494https://doi.org/10.3389/fneur.2018.00494
        • Hillis A.E.
        • Anderson N.
        • Sampath P.
        • et al.
        Cognitive impairments after surgical repair of ruptured and unruptured aneurysms.
        J Neurol Neurosurg Psychiatry. 2000; 69: 608-615https://doi.org/10.1136/jnnp.69.5.608
        • Mayer S.A.
        • Kreiter K.T.
        • Copeland D.
        • et al.
        Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage.
        Neurology. 2002; 59 (2002/12/11): 1750-1758https://doi.org/10.1212/01.wnl.0000035748.91128.c2
        • Haug T.
        • Sorteberg A.
        • Sorteberg W.
        • et al.
        Cognitive outcome after aneurysmal subarachnoid hemorrhage: time course of recovery and relationship to clinical, radiological, and management parameters.
        Neurosurgery. 2007; 60 (discussion 656-647): 649-656https://doi.org/10.1227/01.NEU.0000255414.70807.A0
        • Stienen M.N.
        • Smoll N.R.
        • Weisshaupt R.
        • et al.
        Delayed cerebral ischemia predicts neurocognitive impairment following aneurysmal subarachnoid hemorrhage.
        World Neurosurg. 2014; 82 (20140515): e599-e605https://doi.org/10.1016/j.wneu.2014.05.011
        • Springer M.V.
        • Schmidt J.M.
        • Wartenberg K.E.
        • et al.
        Predictors of global cognitive impairment 1 year after subarachnoid hemorrhage.
        Neurosurgery. 2009; 65 (discussion 1050-1041): 1043-1050https://doi.org/10.1227/01.NEU.0000359317.15269.20
        • Rannikmäe K.
        • Ngoh K.
        • Bush K.
        • et al.
        Accuracy of identifying incident stroke cases from linked health care data in UK Biobank.
        Neurology. 2020; 95 (2020/07/02): e697-e707https://doi.org/10.1212/WNL.0000000000009924
        • Jaja B.N.R.
        • Saposnik G.
        • Lingsma H.F.
        • et al.
        Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study.
        BMJ. 2018; 360: j5745https://doi.org/10.1136/bmj.j5745
        • Yousef K.
        • Crago E.
        • Fisher A.
        • et al.
        3: grading scales in subarachnoid hemorrhage: which scale to control for when studying outcomes.
        Crit Care Med. 2019; 47: 2https://doi.org/10.1097/01.ccm.0000550795.32974.8f
        • Lovelock C.E.
        • Rinkel G.J.
        • Rothwell P.M.
        Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review.
        Neurology. 2010; 74 (20100407): 1494-1501https://doi.org/10.1212/WNL.0b013e3181dd42b3