Cognitive decline, psychological distress and brain atrophy in recovery and residual periods of aneurysmal subarachnoid hemorrhage

Abstract Objective Recent scientific breakthroughs have allowed for new methods of prognostication for aneurysmal subarachnoid hemorrhage (aSAH) to be developed. We aim to verify whether or not initial indicators of these patients' condition in the acute period can predict cognitive decline in the late phase of the disease Methods We examined 114 patients in recovery and residual periods of aneurysmal subarachnoid hemorrhage and divided them into two age groups: Group A, consisting of younger patients from 18 to 44 years (37,72%,), and Group B, with older patients ranging from 45 to 59 years (62,28%).We used MoCA-test (Montreal Cognitive Assessment) to evaluate the cognitive decline, analyzed main parameters of acute period, such as clinical and anatomical type of hemorrhage, Hunt-Hess Grading Scale, Glasgow Coma Scale (GCS). SPSS statistics was applied for the statistical analyses. Results The linear regression method allowed us to build a mathematical model, which is reflecting the relation of cognitive state in the residual period of aSAH from such parameters of the acute period, as GCS score, Hunt-Hess grade (I-V), type of bleeding (numbered: 1 for subarachnoid haemorrhage, 2 - subarachnoid accompanied by parenchymal bleeding, 3 – subarachnoid and ventricular, 4 – subarachnoid with parenchymal and ventricular). The previously fixed mathematical constant has to be used during calculations. According to the formula given below, we can predict the remote cognitive decline, while the patient is in the acute period of the disease. MoCA test score = 28,136 + (- 2,464 * Patient’s age) + (0,106 * GCS) + (- 0,728 * numbered hemorrhage type) + (- 1,064 * Hunt-Hess score number 1-4). Conclusion Thus, the data obtained indicate that patients who have undergone aSAH need an attention and detailed examination similarly to the patients in the acute period. Morphometric indices can be both additional markers of cerebral atrophy and predictors of cognitive decline. Dynamic observation in the recovery and residual periods of aSAH should include the assessment of the quality of life scale, as an additional criterion for assessing the nature and direction of psycho-emotional disorders. Interpretation Apparently, prediction of cognitive decline will help in improvement of treating methods individually for each patient. The prognostic model may be applied by healthcare professionals, neurologists, neurosurgeons.