Long-term outcomes after aneurysmal subarachnoid hemorrhage: A prospective observational cohort study

Long-Term Cognitive Decline After Subarachnoid Hemorrhage: Pathophysiology, Management, and Future Directions

Subarachnoid hemorrhage is a critical neurological condition accounting for about 5% of all strokes, and survivors experience long-term cognitive deterioration and increased risk of dementia. The major processes involved in such decline include early brain injury, delayed cerebral ischemia, neuroinflammation, superficial siderosis, and hydrocephalus. These have emerging treatments that offer promise for the mitigation of effects such as inflammation, iron chelation, and microvascular dysfunction. Genetic predispositions have been associated with post-subarachnoid hemorrhage cognitive outcomes and emphasize a role for personalized care strategies. Management techniques reviewed include long-term cognitive health, such as endovascular coiling and surgical clipping. Other rehabilitation strategies that enhance cognitive reserve and pharmacological interventions are discussed about improving the quality of life in survivors. The review highlights the need for further research into targeted therapies, genetic markers, and innovative approaches to prevent cognitive decline, ultimately aiming to optimize long-term outcomes for individuals affected by subarachnoid hemorrhage.

Classification of life satisfaction by occupational gaps and its characteristics among older adults with care needs

Objective

Occupational therapy aims at enhancing people's life satisfaction, it is important to focus on the occupational gap between "what they want to do" and "what they actually do." This study aimed to describe the characteristics of occupational gap of older adults with care needs who are residing at home, and clarify how the occupational gap patterns classify their life satisfaction.

Method

The Occupational Gap Questionnaire was used to assess the occupational gaps of 209 older adults with care needs (80.1 ± 7.5 years old, 42.1% male), and a Classification and Regression Tree analysis was performed.

Results

The most important factor in classifying participants' life satisfaction was the number of social activities that "they do and want to do," followed by the number of instrumental activities of daily living (IADLs) that "they do not do but want to do".

Conclusion

Our results suggest that promoting participation in social activities and IADLs that participants want to do may improve life satisfaction even when care is needed. Our findings indicate that it is important not only to reduce the occupational gap but also to increase the number of meaningful activities they want to do.

Neurobehavioral Impairments Predict Specific Cerebral Damage in Rat Model of Subarachnoid Hemorrhage

Subarachnoid hemorrhage (SAH) is a severe form of stroke that can cause unpredictable and diffuse cerebral damage, which is difficult to detect until it becomes irreversible. Therefore, there is a need for a reliable method to identify dysfunctional regions and initiate treatment before permanent damage occurs. Neurobehavioral assessments have been suggested as a possible tool to detect and approximately localize dysfunctional cerebral regions. In this study, we hypothesized that a neurobehavioral assessment battery could be a sensitive and specific method for detecting damage in discrete cerebral regions following SAH. To test this hypothesis, a behavioral battery was employed at multiple time points after SAH induced via an endovascular perforation, and brain damage was confirmed via postmortem histopathological analysis. Our results demonstrate that impairment of sensorimotor function accurately predict damage in the cerebral cortex (AUC 0.905; sensitivity 81.8%; specificity 90.9%) and striatum (AUC 0.913; sensitivity 90.1%; specificity 100%), while impaired novel object recognition is a more accurate indicator of damage to the hippocampus (AUC 0.902; sensitivity 74.1%; specificity 83.3%) than impaired reference memory (AUC 0.746; sensitivity 72.2%; specificity 58.0%). Tests for anxiety-like and depression-like behaviors predict damage to the amygdala (AUC 0.900; sensitivity 77.0%; specificity 81.7%) and thalamus (AUC 0.963; sensitivity 86.3%; specificity 87.8%), respectively. This study suggests that recurring behavioral testing can accurately predict damage in specific brain regions, which could be developed into a clinical battery for early detection of SAH damage in humans, potentially improving early treatment and outcomes.

Risk Factors and Clinical Significance of Ultra-Long-Term Microischemia After Intracranial Aneurysm Embolization

INTRODUCTION

This study aimed to explore influencing factors and clinical significance of ultra-long-term microischemia following intracranial aneurysm (IA) embolization and establish a theoretical foundation for reducing both the incidence of ultra-long-term microischemia and cognitive dysfunction in patients post embolization.

METHODS

A retrospective analysis was conducted on data from 147 patients who received endovascular treatment for IAs. Patients were categorized into microischemic and control (non-microischemic) groups on the based on the findings of high-resolution magnetic resonance vessel wall imaging (HR-VWI) examinations performed 3 days postoperatively and 6 months postoperatively. Risk factors for the occurrence of ultra-long-term microischemia were determined by univariate analysis and multivariate logistic regression analysis.

RESULTS

Out of 147 patients included in the study, 51 (34.69%) developed microischemia while the remaining 96 (65.31%) did not experience this condition. Analysis revealed that factors such as sex, age, history of underlying diseases (hypertension, diabetes mellitus), aneurysmal site characteristics, the presence or absence of stenosis in the aneurysm-bearing artery, modified Fisher score at admission, Barthel's index at discharge, immunoinflammatory index at 3 days postoperatively and at the 6-month follow-up, the presence or absence of aneurysmal wall enhancement, and the presence or absence of aneurysmal lumen showed no statistically significant differences between the two groups (all P > 0.05). By contrast, variables like in operative time, rupture status of the aneurysm before surgery according to World Federation of Neurologic Surgeons (WFNS) grade, aneurysm size, number of stents used, number of guidewires and catheters used, and Evans index between the two groups were found to have statistically significant disparities between those who developed microischemia and those who did not (P < 0.05). A subsequent multivariate analysis revealed that aneurysm size, Evans index, and the number of stents used were independent risk factors for the occurrence of ultra-long-term microischemia after surgical intervention of aneurysms (P < 0.05). The receiver operating characteristic (ROC) curves of the patients were constructed on the basis of risk factors determined through multivariate logistic regression analysis. Results indicated that aneurysm size (area under ROC curve (AUC) 0.619, sensitivity 94.7%, specificity 17.1%, P = 0.049), Evans index (AUC 0.670, sensitivity 96.4%, specificity 26.8%, P = 0.004), and number of stents (AUC 0.639, sensitivity 44.6%, specificity 90.2%, P < 0.001) effectively predicted the occurrence of microischemia. The incidence of cognitive dysfunction was higher in the microischemic group than in the control group (P < 0.05), and a greater number of microischemic foci was associated with a higher incidence of cognitive dysfunction. The proportion of microschemia foci in the thalamus and basal ganglia in patients with cognitive dysfunction (60.87%) was significantly higher than that in patients without cognitive dysfunction (34.55%) (P < 0.05).

CONCLUSION

Aneurysm size, Evans index > 0.3, and the quantity of stents were independent risk factors for the occurrence of ultra-long-term microischemia after aneurysm embolization and provided good predictive performance. Cognitive dysfunction was closely associated with microischemia, with its severity increasing with an increase in the number of ischemic foci.

[The effect of surgical technique on the long-term results of treatment of brain aneurysms]

OBJECTIVE

To study the long-term outcomes of surgical treatment of cerebral aneurysms (CA) after using different methods of excluding the aneurysm from the bloodstream.

MATERIAL AND METHODS

We analyzed the long-term results of surgical treatment of 311 patients for CA (on average after 3.5 years). Two hundred and one patients were operated after CA rupture, 110 for an unruptured aneurysm. Microsurgical or endovascular methods were used to isolate the aneurysm from the bloodstream. Upon admission to the hospital for surgical treatment, a clinical diagnostic examination was performed to confirm the diagnosis and determine the timing and type of intervention. In the long-term period, a clinical neurological study, including an assessment of disability with the Barthel index and the modified Rankin scale, cognitive functions (MoCA test) and the psycho-emotional sphere (HADS) was carried out.

RESULTS

In the long-term period of aneurysm surgery, symptoms of disability were identified in 49 patients (16%), severe and complete limitation of self-care in 17 (8%), and cognitive impairment in 212 (68%). Endovascular embolization performance of an aneurysm was associated with a higher proportion of favorable functional outcomes compared with the use of a microsurgical method (10% versus 17%), as well as preservation of cognitive functions (9% and 17%, respectively). Blood clots fibrinolysis was associated with severe disability and dependence in the long-term period (p=0.04). Patients treated with extra-intracranial shunting (EICS) demonstrated better cognitive functions; fibrinolysis, on the contrary, was a predictor of dementia (p=0.02). There was no relationship between symptoms of anxiety and depression in the long-term period and surgical treatment method.

CONCLUSIONS

Disability, dependence and disturbance of cognitive functions in the long-term period of CA surgical treatment are higher in patients after microsurgical clipping compared to endovascular embolization. Performance of blood clots fibrinolysis is associated with severe disability and dementia in patients with massive basal aneurysmal subarachnoid hemorrhage. Performing EICS is associated with a favorable prognosis for the recovery of cognitive functions.

Neurobehavioral impairments predict specific cerebral damage in rat model of subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is a severe form of stroke that can cause unpredictable and diffuse cerebral damage, which is difficult to detect until it becomes irreversible. Therefore, there is a need for a reliable method to identify dysfunctional regions and initiate treatment before permanent damage occurs. Neurobehavioral assessments have been suggested as a possible tool to detect and approximately localize dysfunctional cerebral regions. In this study, we hypothesized that a neurobehavioral assessment battery could be a sensitive and specific early warning for damage in discrete cerebral regions following SAH. To test this hypothesis, a behavioral battery was employed at multiple time points after SAH induced via an endovascular perforation, and brain damage was confirmed via postmortem histopathological analysis. Our results demonstrate that impairment of sensorimotor function accurately predict damage in the cerebral cortex (AUC: 0.905; sensitivity: 81.8%; specificity: 90.9%) and striatum (AUC: 0.913; sensitivity: 90.1%; specificity: 100%), while impaired novel object recognition is a more accurate indicator of damage to the hippocampus (AUC: 0.902; sensitivity: 74.1%; specificity: 83.3%) than impaired reference memory (AUC: 0.746; sensitivity: 72.2%; specificity: 58.0%). Tests for anxiety-like and depression-like behaviors predict damage to the amygdala (AUC: 0.900; sensitivity: 77.0%; specificity: 81.7%) and thalamus (AUC: 0.963; sensitivity: 86.3%; specificity: 87.8%), respectively. This study suggests that recurring behavioral testing can accurately predict damage in specific brain regions, which could be developed into a clinical battery for early detection of SAH damage in humans, potentially improving early treatment and outcomes.