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

Abstract

Objectives: The survival rates for patients affected by aneurysmal subarachnoid hemorrhage (aSAH) have increased in recent years; however, many patients continue to develop cognitive dysfunctions that affect their quality of life. The commonly used outcome measures often fail to identify these cognitive dysfunctions. This study aimed to evaluate the long-term outcomes at 1 and 3 years after aSAH to assess changes over time and relate outcomes to patient characteristics and events during the acute phase.

Materials and methods: This prospective observational study included patients that experienced aSAH. Patients were assessed according to the extended Glasgow Outcome Scale, Life Satisfaction Questionnaire, Mayo-Portland Adaptability inventory-4, and Mental Fatigue scale.

Results: Patients were assessed after 1 year (n = 62) and 3 years (n = 54). At 3 years, the extended Glasgow Outcome Scale score improved in 15% and worsened in 12% of the patients. Mental fatigue was observed in 57% of the patients at 1 year. Patients <60 years of age at the time of aSAH had more self-assessed problems, including pain/headache (p < .01), than patients >60 years of age. Patients with delayed cerebral ischemia during the acute phase reported more dissatisfaction at 3 years, whereas no significant result was seen at 1 year.

Conclusions: Cognitive dysfunction, especially mental fatigue, is common in patients with aSAH, which affects quality of life and recovery. Patient outcome is a dynamic process developing throughout years after aSAH, involving both improvement and deterioration. This study indicates the importance of longer follow-up periods with broad outcome assessments.

Keywords: aneurysmal subarachnoid hemorrhage; cognitive dysfunction; long-term outcome; mental fatigue.

FIGURE 1

Consort flow chart. *Interruption in inclusion for logistics reasons during holidays. ^†Glasgow Outcome Scale extended (GOSE). ^‡Life Satisfaction Checklist (LiSAT‐11) according to Fugl‐Meyer assessment. ^§Mayo‐Portland Adaptability Inventory‐4 (MPAI‐4). ^¶Mental Fatigue Scale (MFS).

FIGURE 2

Changes in self‐assessed outcome between 1 and 3 years according to LiSAT‐11 (Life Satisfaction Questionnaire according to Fugl Meyer) and MPAI‐4 (Mayo‐Portland Adaptability Inventory‐4). Patient outcome difference (improvement or deterioration) between 1 and 3 years after aneurysmal subarachnoid hemorrhage. Items for which more than 25% of patients indicated a change, improvement or deterioration, are presented.

FIGURE 3

The effect on age on self‐assessed outcome according to LiSAT‐11(Life Satisfaction Questionnaire according to Fugl Meyer) and MPAI‐4 (Mayo‐Portland Adaptability Inventory‐4) 1 year after aneurysmal subarachnoid hemorrhage. Items with a significant difference (p<0.05) between patient groups (<60 years and ≥60 years of age). Answer options for LiSAT‐11 dichotomized as satisfied (Very Satisfied/Satisfied/Rather Satisfied) and dissatisfied (Rather Dissatisfied/Dissatisfied/Very dissatisfied). MPAI‐4, dichotomized as no problems (no problems to mild problems no interference with activities) and problems (mild problems with interference/moderate problems/severe problems).

FIGURE 4

The effect of delayed cerebral ischemia (DCI) on self‐assessed outcome according to LiSAT‐11(Life Satisfaction Questionnaire according to Fugl Meyer) and MPAI‐4 (Mayo‐Portland Adaptability Inventory‐4), 3 years after aneurysmal subarachnoid hemorrhage. Items with a significant difference (p < 0.05) between patients diagnosed with DCI or not (non‐DCI) at 3 years are presented. Answer options for LiSAT‐11 dichotomized as satisfied (Very Satisfied/Satisfied/Rather Satisfied) and dissatisfied (Rather Dissatisfied/Dissatisfied/Very dissatisfied). MPAI‐4, dichotomized as no problems (no problems to mild problems no interference with activities) and problems (mild problems with interference/moderate problems/severe problems). ADL=activity of daily living, DCI = delayed cerebral ischemia, nDCI= no delayed cerebral ischemia.