Neuropsychological outcomes following subarachnoid hemorrhage

Abstract

Subarachnoid Hemorrhage (SAH) is a type of stroke which is suggested to result in Executive Functioning (EF) deficits. Within the SAH research, EF is typically considered a multidimensional cognitive construct. However, the nature and extent to which the different components of EF are impacted post SAH remains unclear. Method: In this meta-analysis, ten studies met selection criteria including 248 SAH participants, treated by endovascular coiling. Participants were assessed by standardised EF measures and compared with 230 controls. Searches were conducted in November 2018 including Medline, PsychINFO, Web of Science, Scopus and CINAHL databases. EF measures were assigned to discrete categories including Cognitive Flexibility, Working Memory, Inhibitory Control and Planning/Organisation (Diamond, 2013). Results: A statistically significant effect was found for overall EF. Cognitive Flexibility (G=-0.76) and Inhibitory Control (G= -0.51) generated moderate effect sizes, while Working Memory and Planning/Organisation found a small effect size (G=-0.45 and G=-0.49 respectively). The I! statistic suggested small to moderate heterogeneity between studies, hypothesised to relate to different cognitive tools. Conclusion: Underlying components of EF appear to be differentially impacted post SAH, with Cognitive flexibility demonstrating the largest degree of deficit. Recommendations for a standardised and uniform assessment of EF post SAH are outlined.

Neuropsychological and Psychosocial Outcomes following Subarachnoid Hemorrhage
To explore and compare neuropsychological performance among patients who have experienced a single anterior or posterior subarachnoid hemorrhage (SAH) and have been treated by endovascular coiling. Method: In this study, two groups were created based on site of aneurysm rupture; posterior (77=16) and anterior (n=25) SAH. Neuropsychological function was assessed at least 12 months post aneurysmal SAH, at a regional rehabilitation centre, using a standardised assessment battery. Results: Both groups were similar across age, premorbid IQ and time since injury. The anterior group outperformed the posterior group on 13 out of 16 cognitive tests, by at least a small effect size. A statistically significant and large effect size difference presented on a sentence completion (c/=0.8) and divided attention measure (d=\ .0), favouring the anterior group. Medium effect size differences were found on vocabulary and memory tasks. A number of tests found no group differences, including block design, a spatial anticipation and selective attention measure. Self-reported stress, anxiety and depression did not differ between groups. Conclusion: Different neuropsychological outcomes were found based on site of aneurysm rupture. Posterior SAH was associated with more impaired cognitive functioning. Future research exploring cognitive profile based on site of SAH is recommended.

Date of Award	Dec 2019
Original language	English
Awarding Institution	Queen's University Belfast
Supervisor	David Curran (Supervisor), Martin Dempster (Supervisor) & F. Colin Wilson (Supervisor)