Cognitive impairment in aneurysmal subarachnoid hemorrhage patients with delayed cerebral infarction: prevalence and pattern.

BACKGROUND: Cognitive deficits commonly occur after aneurysmal subarachnoid hemorrhage (aSAH) and clinical understanding is important for treatment and rehabilitation. Delayed cerebral infarction was shown to be related to poor outcome. Data on delayed cerebral infarction-related cognitive impairment were lacking. OBJECTIVE: We investigated the prevalence and pattern of delayed cerebral infarction-associated cognitive impairment. METHODS: We carried out a prospective observational and diagnostic accuracy study in Hong Kong in patients aged 21-75 years with aSAH who had been admitted within 96 h of ictus. The domain-specific neuropsychological assessment battery at 1 year after ictus was used for cognitive assessments. A cognitive domain deficit was defined as a cognitive domain z score less than -1.65 (below the fifth percentile). Cognitive impairment was defined by two or more cognitive domain deficits. The current study is registered at ClinicalTrials.gov of the U.S. National Institutes of Health (NCT01038193). RESULTS: One hundred and twenty aSAH patients were recruited. Patients with delayed cerebral infarction (DCI) have cognitive impairment more frequently (22 % vs 11 %; odds ratio: 2.2, 0.6 to 7.8, p = 0.192). Cognitive domain deficits commonly affected in aSAH patients with delayed cerebral infarction were verbal memory, language, and visuospatial memory and skill domains, and were relatively uncommon in aSAH patients without delayed cerebral infarction. CONCLUSION: In patients with aSAH, delayed cerebral infarction was associated with a specific pattern of cognitive domain deficits. The pathophysiology should be further investigated.