Journal article
Neuropsychological profile and risk factors for poor cognitive outcomes in survivors of aneurysmal subarachnoid hemorrhage
Journal of neurosurgery
12/12/2025
DOI: 10.3171/2025.7.JNS251280
PMID: 41569913
Abstract
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.
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.
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.
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.
Details
- Title: Subtitle
- Neuropsychological profile and risk factors for poor cognitive outcomes in survivors of aneurysmal subarachnoid hemorrhage
- Creators
- Elena Sagues - University of IowaAlex Van Dam - University of IowaNavami Shenoy - University of IowaDiego Ojeda - University of HartfordDaniela Molina - University of IowaCarlos Dier - University of IowaAndres Gudino - University of IowaKathleen E Dlouhy - Departments of4NeurosurgeryMario Zanaty - Departments of4NeurosurgerySantiago Ortega-Gutierrez - University of IowaLinder Wendt - 6Epidemiology, andJames C Torner - University of IowaKenneth W Manzel - University of IowaDaniel T Tranel - University of IowaNatalia García-Casares - Universidad de MálagaEdgar A Samaniego - 5Radiology
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery
- DOI
- 10.3171/2025.7.JNS251280
- PMID
- 41569913
- NLM abbreviation
- J Neurosurg
- ISSN
- 1933-0693
- eISSN
- 1933-0693
- Language
- English
- Electronic publication date
- 12/12/2025
- Academic Unit
- Neurology; Radiology; Epidemiology; Psychological and Brain Sciences; Iowa Neuroscience Institute; Surgery; Injury Prevention Research Center; Neurosurgery
- Record Identifier
- 9985130060302771
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