Abstract WP500: Long-Term Cognitive Outcome Among Aneurysmal Subarachnoid Hemorrhage Survivors: Need for Cognitive Rehabilitation?

Abstract

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high in-patient mortality and with long-term cognitive deficits among survivors. With widespread adoption of standard neurocritical care practice in-hospital mortality has decreased while long-term cognitive impairment (CI) among survivors is not well characterized. Hypothesis: To investigate whether temporal change in practice has resulted in improvement in long-term CI. Methods: Single-center retrospective chart review of aSAH patients admitted to a comprehensive stroke center between January 2012 and December 2016, were identified from a prospective database. Cognitive status was evaluated between January and December 2018 using Telephone Interview of Cognitive Status (TICS). The study cohort was divided into two 2.5 year periods and TICS score of >32, 28-32 and <28 were classified as normal cognitive function, mild and moderate-to-severe CI respectively. The median TICS scores by groups were examined by Wilcoxon or Kruskal-Wallace tests. Categorical variables compared using Chi-squared or Fisher’s exact tests. Results: 252 patients were admitted during the study period of which 46 patients could be reached and consented to participate in TICS. Median TICS score was lower in earlier study period compared to later period [31.5 (IQR 22, 36) vs. 33 (IQR 27, 38), p=0.038]. Similarly, TICS score <28 was seen more often in earlier period as compared to later period [7/22 (6%) vs. 1/24 (0.7%), p=0.044]. Patient who were smokers and had hyperlipidemia had lower TICS score compared to other groups in multivariate model (p=0.007). We found no statistical association between duration of time between discharge date and date of cognitive assessment and TICS groups (Kruskal-Wallace test; p-value=0.074). However, if we treat TICS as a continuous variable in a linear model we observed a significant association between time elapsed and overall TICS score (p=0.0197). For every month increase, there is a decrease in overall TICS by 0.09. Conclusion: Smoking and hyperlipidemia are identified as risk factors for CI among aSAH survivors alluding to a role of vascular pathogenesis. Progressive CI over time might justify long-term cognitive rehabilitation in this population of patients.