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Consequences after aneurysmal subarachnoid hemorrhage: Longitudinal evaluation of cognitive function, emotional health and fatigue
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
2016 (English)Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

Background and purpose: Aneurysmal subarachniod hemorrhage (aSAH) is a type of hemorrhagic stroke

with less severe motoric consequences for the patients affected. However, these patients often experience

hidden symtoms that greatly affects quality of and functioning in every day life. Even though the

subarachnoid type of hemorrhage only accounts for about 5% of all strokes, mean age of occurrence is

much lower than for other stroke subtypes, and the loss of productive life years is therefore substantial.

Previous studies have suggested cognitive impairment, emotional difficulties and fatigue as the hidden

symptoms, however, there is a huge variation of numbers reported. By further investigation of the

longitudinal nature of cognitive impairment, emotional health and fatigue after aSAH this ongoing

prospective cohort study aims to contribute with knowledge to this field and to highlight difficulties that

should be addressed while rehabilitating these patients.

Method: 39 patients with aSAH who had been surgically treated at the Neurosurgical clinic in Umeå,

Sweden, between November 2014 and July 2016 were included in this prospective cohort study with two

follow up time points; 5 months (n=39) and 15 months (n=15) after the event. Cognitive function was tested

using the Montreal Cognitive Assessment (MoCA) at first follow up and a shorter telephone version (the

MoCA 5-minute protocol) was used at second follow up. Data for other symtoms were gathered at both

follow up time points by postal questionnaires including: EuroQol five dimensions questionnaire (EQ-5D),

Hospital Anxiety and Depression scale (HADs), Generalised anxiety disorder 7-item scale (GAD-7), Fatigue

Severity Scale (FSS), modified Ranking Scale (mRS), Stroke Impact Scale 3.0 and 3.0 plus (SIS and SIS+) and

Return to work (RTW) (only at the second follow up). The questionnaires of interest in this part of the study

were HADs, GAD-7, FSS and SIS.

Results: At first follow up after 5 months we found that 40% of the patients (n=14) scored <26 on the MoCA,

which correspond to mild cognitive impairment (MCI). No improvement of cognitive function was observed

at 15-month follow up. Perceived emotional health (evaluated with SIS) was impaired at 5-month follow up

and the median value showed a statistically significant decline at 15-months follow up for paired data. The

screening tools for anxiety and depression (HADs and GAD-7) did not confirm these changes over time at

group level. However, when paired 7-28% of the patients did score much higher the second time, reaching

levels over cut off for further investigation on HADs and GAD-7. About half of the study population were

suffering from clinical fatigue at first follow up with no statistically significant improvement over time.

Conclusion: Cognitive impairment, emotional difficulties and fatigue are common symptoms after aSAH that

should be regarded early in the process of rehabilitation. Their longitudinal pattern need to be furtherinvestigated as this study continues.

Place, publisher, year, edition, pages
2016.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-134117OAI: oai:DiVA.org:umu-134117DiVA: diva2:1091473
Educational program
Medical Programme
Supervisors
Available from: 2017-05-05 Created: 2017-04-26 Last updated: 2017-05-05Bibliographically approved

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