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Open Access 01-04-2020 | Subarachnoid Hemorrhage | Original Article

Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage

Authors: Ilari M. Rautalin, Martina Sebök, Menno R. Germans, Miikka Korja, Noemi Dannecker, Olivia Zindel-Geisseler, Peter Brugger, Luca Regli, Martin N. Stienen

Published in: Neurological Sciences | Issue 4/2020

Abstract

Background

Although most aneurysmal subarachnoid hemorrhage (aSAH) patients suffer from neuropsychological disabilities, outcome estimation is commonly based only on functional disability scales such as the modified Rankin Scale (mRS). Moreover, early neuropsychological screening tools are not used routinely.

Objective

To study whether two simple neuropsychological screening tools identify neuropsychological deficits (NPDs), among aSAH patients categorized with favorable outcome (mRS 0—2) at discharge.

Methods

We reviewed 170 consecutive aSAH patients that were registered in a prospective institutional database. We included all patients graded by the mRS at discharge, and who had additionally been evaluated by a neuropsychologist and/or occupational therapist using the Montreal Cognitive Assessment (MoCA) and/or Rapid Evaluation of Cognitive Function (ERFC). The proportion of patients with scores indicative of NPDs in each test were reported, and spearman correlation tests calculated the coefficients between the both neuropsychological test results and the mRS.

Results

Of the 42 patients (24.7%) that were evaluated by at least one neuropsychological test, 34 (81.0%) were rated mRS 0—2 at discharge. Among these 34 patients, NPDs were identified in 14 (53.9%) according to the MoCA and 8 (66.7%) according to the ERFC. The mRS score was not correlated with the performance in the MoCA or ERFC.

Conclusion

The two screening tools implemented here frequently identified NPDs among aSAH patients that were categorized with favorable outcome according to the mRS. Our results suggest that MoCA or ERFC could be used to screen early NPDs in favorable outcome patients, who in turn might benefit from early neuropsychological rehabilitation.

Korja M, Silventoinen K, Laatikainen T, Jousilahti P, Salomaa V, Kaprio J (2013) Cause-specific mortality of 1-year survivors of subarachnoid hemorrhage. Neurology 80(5):481–486. https://doi.org/10.1212/WNL.0b013e31827f0fb5 CrossRefPubMedPubMedCentral

Lovelock CE, Rinkel GJ, Rothwell PM (2010) Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review. Neurology 74(19):1494–1501. https://doi.org/10.1212/WNL.0b013e3181dd42b3 CrossRefPubMedPubMedCentral

Stienen MN, Weisshaupt R, Fandino J, Fung C, Keller E, Hildebrandt G, Studerus-Germann A, Muri R, Gutbrod K, Blasi S, Monsch AU, Brugger P, Mondadori C, Sailer M, Bijlenga P, Schaller K, Schatlo B, Swiss SOSsg (2013) Current practice in neuropsychological outcome reporting after aneurysmal subarachnoid haemorrhage. Acta Neurochir 155 (11):2045–2051. doi:https://doi.org/10.1007/s00701-013-1823-9

Saver JL, Filip B, Hamilton S, Yanes A, Craig S, Cho M, Conwit R, Starkman S, Investigators F-M, Coordinators (2010) Improving the reliability of stroke disability grading in clinical trials and clinical practice: the Rankin focused assessment (RFA). Stroke 41 (5):992–995. doi:https://doi.org/10.1161/STROKEAHA.109.571364

Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1(7905):480–484CrossRef

Hutter BO, Gilsbach JM (1993) Which neuropsychological deficits are hidden behind a good outcome (Glasgow = I) after aneurysmal subarachnoid hemorrhage? (0148-396X (print))

Fung C, Beck J, Lauber L, Muri R, Raabe A, Nyffeler T (2012) Clinical assessment of deficits after SAH: hasty neurosurgeons and accurate neurologists. J Neurol 259(10):2198–2201. https://doi.org/10.1007/s00415-012-6483-9 CrossRefPubMed

Stienen Martin N, Smoll Nicolas R, Fung C, Goldberg J, Bervini D, Maduri R, Chiappini A, Robert T, May A, Bijlenga P, Zumofen D, Roethlisberger M, Seule Martin A, Marbacher S, Fandino J, Schatlo B, Schaller K, Keller E, Bozinov O, Regli L, null n, Burkhardt J-K, Neidert Marian C, Maldaner N, Finkenstädt S, Schöni D, Raabe A, Beck J, Mariani L, Guzman R, D’Alonzo D, Daniel Roy T, Reinert M, Ferrari A, Hildebrandt G, Weyerbrock A, Corniola M (2018) Home-time as a surrogate marker for functional outcome after aneurysmal subarachnoid hemorrhage. Stroke 49 (12):3081–3084. doi:https://doi.org/10.1161/STROKEAHA.118.022808

Rinkel GJ, Algra A (2011) Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol 10(4):349–356. https://doi.org/10.1016/S1474-4422(11)70017-5 CrossRefPubMed

10.

Al-Khindi T, Macdonald RL, Schweizer TA (2010) Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. Stroke 41(8):e519–e536. https://doi.org/10.1161/STROKEAHA.110.581975 CrossRefPubMed

11.

Ravnik J, Starovasnik B, Sesok S, Pirtosek Z, Svigelj V, Bunc G, Bosnjak R (2006) Long-term cognitive deficits in patients with good outcomes after aneurysmal subarachnoid hemorrhage from anterior communicating artery. Croat Med J 47(2):253–263PubMedPubMedCentral

12.

Haug T, Sorteberg A, Finset A, Lindegaard KF, Lundar T, Sorteberg W (2010) Cognitive functioning and health-related quality of life 1 year after aneurysmal subarachnoid hemorrhage in preoperative comatose patients (Hunt and Hess grade V patients). Neurosurgery 66(3):475–484; discussion 484-475. https://doi.org/10.1227/01.NEU.0000365364.87303.AC CrossRefPubMed

13.

Greebe P, Rinkel GJ, Algra A (2010) Long-term outcome of patients discharged to a nursing home after aneurysmal subarachnoid hemorrhage. Arch Phys Med Rehabil 91(2):247–251. https://doi.org/10.1016/j.apmr.2009.10.008 CrossRefPubMed

14.

Zweifel-Zehnder AE, Stienen MN, Chicherio C, Studerus-Germann A, Blasi S, Rossi S, Gutbrod K, Schmid N, Beaud V, Mondadori C, Brugger P, Sacco L, Muri R, Hildebrandt G, Fournier JY, Keller E, Regli L, Fandino J, Mariani L, Raabe A, Daniel RT, Reinert M, Robert T, Schatlo B, Bijlenga P, Schaller K, Monsch AU, Swiss SOSsg (2015) Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations. Acta Neurochir 157 (9):1449–1458. doi:https://doi.org/10.1007/s00701-015-2480-y

15.

Haug Nordenmark T, Karic T, Sorteberg W, Sorteberg A (2019) Predictors of cognitive function in the acute phase after aneurysmal subarachnoid hemorrhage. Acta Neurochir 161(1):177–184. https://doi.org/10.1007/s00701-018-3760-0 CrossRefPubMed

16.

Sarnthein J, Stieglitz L, Clavien PA, Regli L (2016) A patient registry to improve patient safety: recording general neurosurgery complications. PLoS One 11(9):e0163154. https://doi.org/10.1371/journal.pone.0163154 CrossRefPubMedPubMedCentral

17.

Teasdale GM, Drake CG, Hunt W, Kassell N, Sano K, Pertuiset B, De Villiers JC (1988) A universal subarachnoid hemorrhage scale: report of a committee of the world federation of neurosurgical societies. J Neurol Neurosurg Psychiatry 51(11):1457. https://doi.org/10.1136/jnnp.51.11.1457 CrossRefPubMedPubMedCentral

18.

Neidert MC, Maldaner N, Stienen MN, Roethlisberger M, Zumofen DW, D'Alonzo D, Marbacher S, Maduri R, Hostettler IC, Schatlo B, Schneider MM, Seule MA, Schoni D, Goldberg J, Fung C, Arrighi M, Valsecchi D, Bijlenga P, Schaller K, Bozinov O, Regli L, Burkhardt JK, Swiss SOSsg (2018) The Barrow neurological institute grading scale as a predictor for delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage: data from a Nationwide patient registry (Swiss SOS). Neurosurgery 83 (6):1286–1293. doi:https://doi.org/10.1093/neuros/nyx609

19.

Wong GK, Lam SW, Wong A, Ngai K, Poon WS, Mok V (2013) Comparison of Montreal cognitive assessment and mini-mental state examination in evaluating cognitive domain deficit following aneurysmal subarachnoid haemorrhage. PLoS One 8(4):e59946. https://doi.org/10.1371/journal.pone.0059946 CrossRefPubMedPubMedCentral

20.

Wong GK, Lam SW, Wong A, Lai M, Siu D, Poon WS, Mok V (2014) MoCA-assessed cognitive function and excellent outcome after aneurysmal subarachnoid hemorrhage at 1 year. Eur J Neurol 21(5):725–730. https://doi.org/10.1111/ene.12363 CrossRefPubMed

21.

Lees KR, Bath PM, Schellinger PD, Kerr DM, Fulton R, Hacke W, Matchar D, Sehra R, Toni D, European Stroke Organization Outcomes Working G (2012) Contemporary outcome measures in acute stroke research: choice of primary outcome measure. Stroke 43(4):1163–1170. https://doi.org/10.1161/STROKEAHA.111.641423 CrossRef

22.

Stienen MN, Visser-Meily JM, Schweizer TA, Hanggi D, Macdonald RL, Vergouwen MDI, Unruptured Intracranial A, Investigators SCP (2019) Prioritization and timing of outcomes and endpoints after aneurysmal subarachnoid hemorrhage in clinical trials and observational studies: proposal of a multidisciplinary research group. Neurocrit Care 30(Suppl 1):102–113. https://doi.org/10.1007/s12028-019-00737-0 CrossRefPubMed

23.

Data Coordination Unit at Medical University of South Carolina WebDCU™ Comprehensive Clinical Trial Management System (https://webdcu.musc.edu/campus/). (2004)

24.

Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P, International Subarachnoid Aneurysm Trial Collaborative G (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366(9488):809–817. https://doi.org/10.1016/S0140-6736(05)67214-5 CrossRef

25.

Stienen MN, Fung C, Bijlenga P, Zumofen DW, Maduri R, Robert T, Seule MA, Marbacher S, Geisseler O, Brugger P, Gutbrod K, Chicherio C, Monsch AU, Beaud V, Rossi S, Fruh S, Schmid N, Smoll NR, Keller E, Regli L, Mo CADCIsg (2018) Measuring the impact of delayed cerebral ischemia on neuropsychological outcome after aneurysmal subarachnoid hemorrhage-protocol of a Swiss Nationwide observational study (MoCA-DCI study). Neurosurgery. doi:https://doi.org/10.1093/neuros/nyy155

26.

Schweizer TA, Al-Khindi T, Macdonald RL (2012) Mini-mental state examination versus Montreal cognitive assessment: rapid assessment tools for cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. J Neurol Sci 316(1–2):137–140. https://doi.org/10.1016/j.jns.2012.01.003 CrossRefPubMed

27.

Wong GK, Lam S, Ngai K, Wong A, Mok V, Poon WS, Cognitive Dysfunction after Aneurysmal Subarachnoid Haemorrhage I (2012) Evaluation of cognitive impairment by the Montreal cognitive assessment in patients with aneurysmal subarachnoid haemorrhage: prevalence, risk factors and correlations with 3 month outcomes. J Neurol Neurosurg Psychiatry 83 (11):1112–1117. doi:https://doi.org/10.1136/jnnp-2012-302217

28.

Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005) The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x CrossRef

29.

Gil RT, G, Pluchon C, Micheneau D, Cariou B, Rivault L, Sicot I, Boissonnot L, Neau JP. (1987) A method for rapid evaluation of cognitive faculties (ERFC) – use in Alzheimer senile dementia. Semanie des Hopitaux 67:2127–2133

30.

Billon R (1991) Une méthode d'évaluation rapide des fonctions cognitives et une épreuve raccourcie. Revue de Gériatrie 16(5):229–234

31.

Kemoun G, Thibaud M, Roumagne N, Carette P, Albinet C, Toussaint L, Paccalin M, Dugue B (2010) Effects of a physical training programme on cognitive function and walking efficiency in elderly persons with dementia. Dement Geriatr Cogn Disord 29(2):109–114. https://doi.org/10.1159/000272435 CrossRefPubMed

32.

Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum, New Jersey

33.

Weisscher N, Vermeulen M, Roos YB, Haan RJ (2008) What should be defined as good outcome in stroke trials; a modified Rankin score of 0–1 or 0–2? J Neurol 255(6):867–874. https://doi.org/10.1007/s00415-008-0796-8 CrossRefPubMed

34.

Kim DH, Haney CL, Van Ginhoven G (2005) Utility of outcome measures after treatment for intracranial aneurysms: a prospective trial involving 520 patients. Stroke 36(4):792–796. https://doi.org/10.1161/01.STR.0000157594.58180.97 CrossRefPubMed

35.

Eagles ME, Tso MK, Macdonald RL (2019) Cognitive impairment, functional outcome, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. World Neurosurg. https://doi.org/10.1016/j.wneu.2018.12.152

36.

Wong GK, Lam SW, Wong A, Mok V, Siu D, Ngai K, Poon WS (2014) Early MoCA-assessed cognitive impairment after aneurysmal subarachnoid hemorrhage and relationship to 1-year functional outcome. Transl Stroke Res 5(2):286–291. https://doi.org/10.1007/s12975-013-0284-z CrossRefPubMed

37.

Passier PE, Visser-Meily JM, van Zandvoort MJ, Post MW, Rinkel GJ, van Heugten C (2010) Prevalence and determinants of cognitive complaints after aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis 29(6):557–563. https://doi.org/10.1159/000306642 CrossRefPubMed

38.

Rivero-Arias O, Gray A, Wolstenholme J (2010) Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom. Cost Eff Resour Alloc 8:6. https://doi.org/10.1186/1478-7547-8-6 CrossRefPubMedPubMedCentral

39.

Macdonald RL, Cusimano MD, Etminan N, Hanggi D, Hasan D, Ilodigwe D, Jaja B, Lantigua H, Le Roux P, Lo B, Louffat-Olivares A, Mayer S, Molyneux A, Quinn A, Schweizer TA, Schenk T, Spears J, Todd M, Torner J, Vergouwen MD, Wong GK, Collaboration S (2013) Subarachnoid hemorrhage international Trialists data repository (SAHIT). World Neurosurg 79(3–4):418–422. https://doi.org/10.1016/j.wneu.2013.01.006 CrossRef

40.

Idorsia Pharmaceuticals Ltd Clinical Research Study With Clazosentan to Evaluate Its Effects on Preventing Complications Due to the Narrowing of the Blood Vessels (Vasospasm) in the Brain, Caused by Bleeding Onto the Surface of the Brain, Identifier NCT03585270 ClinicalTrials.gov (2018)

Title: Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage
Authors: Ilari M. Rautalin
Martina Sebök
Menno R. Germans
Miikka Korja
Noemi Dannecker
Olivia Zindel-Geisseler
Peter Brugger
Luca Regli
Martin N. Stienen
Publication date: 01-04-2020
Publisher: Springer International Publishing
Keywords: Subarachnoid Hemorrhage
Subarachnoid Hemorrhage
Published in: Neurological Sciences / Issue 4/2020
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-019-04159-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage

Abstract

Background

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

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