Time-course of neuropsychological functioning in aneurysmal subarachnoid hemorrhage and its association with vasospasm

TL;DR

This study tracks cognitive recovery in patients with aneurysmal subarachnoid hemorrhage and finds that most impairments improve over 18 months, despite initial severe effects.

Contribution

The study provides a detailed time-course of cognitive recovery and the impact of vasospasm in aSAH patients over 18 months.

Findings

High cognitive impairments were observed immediately after aSAH, especially in memory and executive functions.

Most cognitive functions showed gradual improvement over 18 months, with vasospasm's effects diminishing over time.

Chronic phase showed low prevalence of impairments, suggesting significant recovery potential in aSAH survivors.

Abstract

Aneurysmal subarachnoid hemorrhages (aSAH) and related vasospasm often cause several neurological and cognitive impairments in survivors. The long-term impact of aSAH and vasospasm on cognition remains a topic of debate. This study aims to describe cognitive functioning, focusing on the acute phases after bleeding and for 18 months, and to investigate the immediate and long-term effects of vasospasm.

Seventy adult patients were prospectively recruited and tested at different time points: within 48/72 h after bleeding (T1); between 7 and 10 days after bleeding (T2); and five long-term follow-ups from 1 (T3) to 18 months (T7). An extensive neuropsychological evaluation was administered, including the level of daily functional independence.

At T1, all tests showed high percentages of impairments (ranging from 38 to 100%), in particular for visual and verbal long-term memory, constructional praxis, abstract reasoning, and functional independence. Many tasks have gradually improved since T2, except for executive functions and visual memory, which show a slower recovery. A severe diffuse impact of vasospasm emerged at T2, but a linear, gradual recovery emerged since T3 for almost all the investigated functions. At the last follow-ups, several tests showed no significant differences between patients with and without vasospasm.

Despite severe diffuse impact of bleeding and vasospasm in the acute stages, a low prevalence of cognitive and functional impairments in the chronic phase emerges. Our data may help clinicians to better understand the cognitive and autonomy trajectories of recovery over time and to tailor eventual rehabilitation programs.

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