Abstract WP448: Cognitive Deficits In Patients With Aneurysmal Subarachnoid Hemorrhage Can Be Screened By Montreal Cognitive Assessment And Correlate With Functional Outcomes

Abstract

Objective: Cognitive impairment after aneurysmal subarachnoid hemorrhage (aSAH) is common and important for patient management (medical treatment, cognitive rehabilitation, and social arrangements). The Montreal Cognitive Assessment (MoCA) was recently applied as the screening test for vascular cognitive impairment after acute ischemic stroke. We hypothesized that cognitive deficits in patients with aneurysmal subarachnoid hemorrhage can be screened by Montreal Cognitive Assessment and correlate with functional outcomes. Methods: We carried out a prospective observational and diagnostic accuracy study in Hong Kong over a 38 month period, and recruiting 173 patients aged 21 to 75 years with aSAH admitted within 96 hours of ictus. The assessments are domain-specific neuropsychological assessment battery, MoCA, MMSE, modified Rankin Scale, and Lawton Instrumental Activity of Daily Living at 2-4 weeks (n=74) and 1 year (n=80) after ictus. The current study is registered at ClinicalTrials.gov of the U.S. National Institutes of Health ( NCT01038193 ). Results: Unfavorable outcome (mRS 3-5) and dependent instrumental activity of daily living (IADL<15) correlated with visuospatial memory and skill and language domain deficits at 2-4 weeks and with significant cognitive impairment and all cognitive domain deficits except attention and working memory at 1 year. At 2-4 weeks, the AUCs were similar between MoCA and MMSE for cognitive domain deficits and cognitive impairment; at 1 year, MoCA had higher AUCs than MMSE for significant cognitive impairment and all cognitive domain deficits except visuospatial memory and skill. Interpretation: Cognitive deficits in patients with aneurysmal subarachnoid hemorrhage can be screened by MoCA and correlate with functional outcomes in both subacute and chronic phases.