Long-term functional and neuropsychological outcomes of subarachnoid haemorrhage (SAH) survivors

Abstract

Stroke is the second commonest cause of death worldwide and the most frequent cause of disability in adults. Although Subarachnoid Haemorrhage (SAH) accounts for a small percentage of stroke, it impacts people at a younger age and with debilitating consequences, in the areas of mood, functioning and cognitive deficits which may persist for years after the SAH. However, very little research has been done to examine the long-term (beyond 1-3 years) outcomes of SAH. Furthermore, previous studies have not been population based, nor have they examined the impact of long-term cognitive outcomes using a battery of neuropsychological tests. The current population based study examined long-term neuropsychological and functional outcomes of SAH survivors (n=27). A control group (n=26) matched on age, gender and ethnicity was used to compare the mood, functional (i.e., disability, handicap, quality of life) and neuropsychological outcomes (i.e., verbal memory, visual memory, executive functioning, language, processing speed and visuoperceptual abilities) of SAH survivors. As compared to the controls, the SAH group was more depressed and was significantly impaired in the areas of disability, handicap, quality of life; particularly in the areas of mental health with females reporting poor mental health than males within the SAH group. Furthermore, the SAH group had significant deficits across cognitive domains (i.e., language, memory, visuoperceptual abilities, executive functioning/attention and information processing) when compared to controls. Although impairments were noted at 5-years post-SAH, over time (i.e., from acute stage) significant improvement had occurred in the areas of functioning (i.e., disability, health related quality of life and well-being) of SAH survivors. Depressed mood and baseline functioning were related to worse functional outcomes at 5-years post-SAH. Whilst poor cognitive functioning impacted the long-term functional outcomes of SAH survivors only, visual memory and language were found to independently relate to worse functional outcomes of SAH-survivors. The finding that long-term neuropsychological impairment in SAH-survivors is independently associated with the functional outcomes at 5-years post-SAH provides a new direction for the rehabilitation efforts which have traditionally focussed on physical functioning and activities of daily living. Thus, these findings are of relevance to clinicians to help them understand the expected cognitive deficits and their potential to impact on wider functional outcomes of SAH survivors, thereby allowing the clinicians to plan appropriate interventions for rehabilitations.