Neuropsychological, Psychological and Functional Outcomes 12-Months Post-Subarachnoid Haemorrhage: Population-Based Sample Compared to Matched Controls

Abstract

Stroke is a common neurological disorder that is a leading cause of disability worldwide and may result in deterioration of functioning in neuropsychological, psychological and functional abilities. While accounting for a small proportion of all strokes, subarachnoid haemorrhage (SAH) affects a comparatively young age group who live with its burden for longer. A thorough understanding of SAH survivors’ short-term (≤12-months) outcomes and trajectory is imperative as most change and rehabilitation occurs during this time. However, previous research has been limited by use of hospital- and clinic-based samples, comparison to normative data, limited outcomes focus, and use of brief measures. The current population-based study examined SAH survivors’ (n=30) outcomes throughout the first 12-months compared to control participants (n=29) matched on age, gender and ethnicity. Both groups were assessed using a neuropsychological test battery (e.g., verbal and visual memory, cognitive flexibility, processing speed, cognitive screening measure) and on psychological (anxiety, depression, overall) and functional (stroke symptoms, disability, health related quality of life [HRQoL]) outcomes; the SAH group at 28-days, 6- and 12-months post-SAH. As compared to controls, the SAH group performed significantly worse with greater proportions falling in the impaired range on some neuropsychological outcomes (e.g., cognitive screening measure) and most psychological and HRQoL outcomes throughout the 12-months, despite good outcomes regarding stroke symptoms and disability. Some early improvement in outcomes was found but this plateaued during the 6- to 12-month period and SAH survivors’ outcomes remained poor compared to controls. Psychological and HRQoL outcomes in particular were interrelated, with previous stroke and surgical clipping related to worse HRQoL outcomes. The current findings demonstrate the importance of psychological and HRQoL outcomes in particular throughout the first 12-months post-SAH as compared to the more frequent emphasis of stroke symptoms and disability, suggesting a different direction for assessment and intervention focus. Neuropsychological outcomes are also impaired, though more research using a larger population-based sample and test battery are required to better understand domain specific impairment, trajectory and relation to other outcomes.