Differences in Neuropsychological Profiles of Long-Term Intracerebral Hemorrhage and Subarachnoid Hemorrhage Survivors

Abstract

Most literature regarding cognition post-stroke examines ischemic stroke. Cognitive deficits reported postintracerebral hemorrhage (ICH) include aphasia/fluency, visuo-spatial ability, memory and executive functioning (1,2). After subarachnoid hemorrhage (SAH) deficits occur in language, processing speed, memory, and executive function (3). To compare cognition of 5-year SAH (n = 27) and ICH (n = 34) survivors, data from the Auckland Stroke Outcomes (ASTRO) study were used (4,5). As seen in Fig. 1, SAH and ICH participants produced scores normative means (z-score = 0) on measures of prudence (IVA-CPT), verbal memory (Logical Memory), and figure color memory (VPA). Those with SAH were also above the normative mean on visual construction (BD). There was no significant main effect of group, F (1,23) = 0·18, p = 0·673. Scores deviated significantly from flatness, F (9,15) = 6·511, p = 0·004, but not from parallelism, F (9,15) = 0·612, p = 0·807. Thus overall mean cognitive deficits did not differ between groups, but differed in tests where high/low scores were obtained. Post hoc analyses (Bonferroni) indicate that SAH survivors performed significantly better than survivors of ICH on auditory attention (IVA-CPT [p = 0·036]), processing speed (Trails A & B, Stroop Dots [p = 0·016, 0·047, and 0·019]), visual construction (Rey Fig. copy [p = 0·024], Block Design [p = 0·019]) and visual memory (Rey Fig. recall [p = 0·021]). Thus, tasks reliant on executive functions, processing speed and visual construction were the most impaired. Despite similarities in the literature, ICH and SAH samples produced significantly different cognitive profiles. ICH survivors performed worse, particularly on visual attention, organization/problem solving tasks (IVA-CPT, Rey copy, BD, Trails) and visual memory (Rey Recall). It should be noted that poor Rey copy performance impacts Rey recall. While group differences identified here may in part be attributed to our use of a populationbased sample and extended follow-up period, no direct comparisons of SAH and ICH groups on cognition test could be located; with most comparative studies limited to mortality and morbidity.