Introduction: The cognitive impairments following treatment of ruptured aneurysms have often been underestimated. This study was to assess their prevalence and analyze various associated factors.
Methods: Patients who were operated for ruptured anterior circulation aneurysms with GOS of 4-5 at 3 months were studied for cognitive impairments using continuous scales of memory (recent, remote and overall memory), verbal fluency (phonemic and category fluency), and digit symbol substitution test (DSST), in relation to various factors. Univariate and multivariate analyses were performed using SPSS21.
Results: There were a total of 87 patients included in our study. Memory assessment was carried out in all, category fluency could be performed only in 84, phonemic fluency in 83, and DSST in 67 patients. The median overall memory of patients was 65 (IQR 53-75) in the scale of 101. Adjusting for age and education, 13 (15%) and 6 (7%) patients had moderate and severe impairment in recent memory, and 19 (22%) and 12 (14%) had moderate and severe impairment in remote memory respectively. Adjusting for age, gender and education, 50 (60%) had impairment in category fluency, 55 (66%) had impairment in phonemic fluency, and 37 (55%) had impairment in DSST. Patients operated for anterior cerebral artery (Acom & DACA) aneurysms have significantly greater impairments in recent and remote memory compared to others, both in univariate (p values 0.01 & 0.002 respectively) and multivariate analysis (p values 0.01 & 0.03 respectively). They also had significantly greater independent impairment in phonemic fluency (p value 0.04), compared to others. WFNS grade had significant independent impact on only remote memory (p value 0.01).
Conclusions: Cognitive impairments are frequent following treatment of ruptured anterior circulation aneurysms. Impairments in recent memory, remote memory and phonemic fluency are significantly greater following treatment of anterior cerebral artery (Acom & DACA) aneurysms, compared to others, independent of other factors.
Patient Care: Studies on ruptured aneurysms should include outcome data on cognitive impairments.
Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the cognitive impairments in patients following treatment of ruptured anterior circulation aneurysms, 2)Discuss various factors associated with different cognitive impairments.