Unruptured intracranial aneurysm treatment effects on cognitive function: a meta-analysis

Abstract

Objective: The treatment of an unruptured intracranial aneurysm (UIA) is not free of morbidity and mortality, and the decision is made by weighing the risks of treatment complications against the risk of aneurysm rupture. This meta-analysis quantitatively analyzed the literature on the effects of UIA treatment on cognition.

Methods: MEDLINE, Embase, and PsycInfo were systematically searched for studies that reported on the cognitive status of UIA patients before and after aneurysm treatment. The search was restricted to prospective cohort and case-control studies published between January 1, 1998, and January 1, 2013. The analyses focused on the effect of treatment on general cognitive functioning, with an emphasis on 4 specific cognitive domains: executive functions, verbal and visual memory, and visuospatial functions.

Results: Eight studies, with a total of 281 patients, were included in the meta-analysis. Treatment did not affect general cognitive functioning (effect size [ES] -0.22 [95% CI -0.78 to 0.34]). Executive functions and verbal memory domains trended toward posttreatment impairment (ES -0.46 [95% CI -0.93 to 0.01] and ES -0.31 [95% CI -1.24 to 0.61]), and performance of visual memory tasks trended toward posttreatment improvement (ES 1.48 [95% CI -0.36 to 3.31]). Lastly, treatment did not significantly affect visuospatial functions (ES -0.08 [95% CI -0.30 to 0.45]).

Conclusions: The treatment of an UIA does not seem to affect long-term cognitive function. However, definitive conclusions were not possible due to the paucity of studies addressing this issue.

Keywords: ALVT = Auditory Verbal Learning Test; CLVT-II = California Verbal Learning Test II; CWIT = Color Word Interference Task; ES = effect size; ISUIA = International Study of Unruptured Intracranial Aneurysms; LM = Logical Memory; MMSE = Mini-Mental State Examination; NOS = Newcastle-Ottawa Scale; ROCF = Rey-Osterrieth Complex Figure; TMT-B = Trail Making Test Part B; UIA = unruptured intracranial aneurysm; aSAH = aneurysmal subarachnoid hemorrhage; cognition; endovascular coiling; surgical clipping; unruptured intracranial aneurysm; vascular disorders.