CHANGES OF COGNITIVE SPHERE IN PATIENTS IN RECOVERY AND RESIDUAL PERIODS OF ANEURYSMAL SUBARACHNOID HAEMORRHAGE

Abstract

The aneurysmal subarachnoid haemorrhage (aSAH) is characterized by high mortality (from 32 up to 67 %), high frequency of neurological complications, significant disability of patients and decreasing of quality of life [1].

The statistical data indicate that changes in the cognitive sphere of patients, who have suffered aSAH, are exacerbated by the pre­sence of depression, anxiety and sleep disturbances [10].

The aim of the study – to examine the changes of cognitive sphere in patients who suffered aSAH according to age, sex, severity of SAH in acute period (The Hunt and Hess Scale), clinic-anatomical type of haemorrhage, aneurysm localization and kind of surgical intervention.

Materials and Methods. A total of 114 patients were examined in age of 22–59 years, of whom 74 were men and 40 women. Cognitive impairment was assessed by means of Montreal Cognitive deficit Scale (test MoCA). The level of functional recovery and disability was measured by Modified Rankin Scale – mRS). In order to measure performance in activities of daily living (ADL) we used Barthel Activities of Daily Living Index. The state of the psychoemotional sphere was assessed using the Hospital Anxiety and Depression Scale (HADS).

Results and Discussion. Cognitive impairment of different severity ranges was found in 85.96 % cases: mild – in 43.86 %, moderate – in 23.69 %, dementia – in 18.42 %. Among all the items, major changes were discovered in visuospatial abilities, language and memory. Patients who had the depression showed lower MoCA-test results (r=-0.325; p=0,001). It was found the correlation between the overall Moca-test result and severity of SAH in acute period (Hunt-Hess Scale) - (r=-0.310; p=0.001) and Bathel index - (r=0.305; p=0.001). The statistically reliable difference in overall MoCA-test results was absent in groups of patients divided according to age, sex, aneurysm localization and kind of surgical intervention. However, significantly lower (p<0.01) MoCA-test results were observed in group of patients, who had subarachnoid haemorrhage accompanied by parenchymal and ventricular bleeding ((19.09±1.83) points) compared to a group of patients suffered from subarachnoid form of haemorrhage ((22 .84 ±0.43) points).

Conclusions. The average MoCA-test result was (21.71±0.37) points, that corresponds to a moderate cognitive impairment. According to the obtained data, the most significant changes were discovered in the visuospatial abilities, language and memory (p <0.05).