Neuropsychological profile and risk factors for poor cognitive outcomes in survivors of aneurysmal subarachnoid hemorrhage

OBJECTIVE: Authors of this study aimed to characterize the neuropsychological profile of survivors of aneurysmal subarachnoid hemorrhage (aSAH) and identify clinical variables associated with poor cognitive outcomes. METHODS: This retrospective observational study included patients with an aSAH diagnosis from 2009 to 2024. Cognitive outcomes were assessed at least 6 months after aSAH using the 22-item Montreal Cognitive Assessment (MoCA-22), Digit Span Test Forward (DST-F), Digit Span Test Backward (DST-B), and Verbal Fluency Test (VFT). Poor cognitive outcomes were defined as an MoCA-22 score < 25th percentile for population norms. Multivariable logistic regression was used to identify factors associated with poor cognitive outcomes. A subset of patients also completed the Beck Depression Inventory II, Stroke-Specific Quality of Life Scale, and Iowa Scales of Personality Change. RESULTS: A total of 156 patients were included. Fifty-three patients (34%) had an MoCA-22 score < 25th percentile, even though 79% of them had a modified Rankin Scale score ≤ 2 at discharge. Moderate and severe deficits (z-score < 1 SD) were observed in 11% of patients (17/156) on the DST-F, 27% (42/156) on the DST-B, and 9% (14/156) on the VFT. A modified Fisher grade 4 on admission (36/53, 68% vs 45/103, 44%) and infarction during hospitalization (16/53, 30% vs 11/103, 11%) were significantly associated with poor cognitive outcomes (adjusted odds ratio [aOR] 2.43, IQR 1.17-5.16, p = 0.018; and aOR 2.71, IQR 1.10-6.79, p = 0.029, respectively). Infarction also negatively impacted work productivity (OR 0.69, p = 0.015) and social relationships (OR 0.72, p = 0.029). Additionally, 27% of patients (12/44) reported at least mild depressive symptoms and 64% (29/45) acquired a personality disturbance. CONCLUSIONS: Survivors of aSAH can experience neuropsychological deficits, particularly those affecting executive function and working memory, despite good functional recovery. In this study, a modified Fisher grade 4 and new radiological infarction during hospitalization were associated with poor cognitive outcomes.