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Neurosurgery. 2019 May 1;84(5):1124-1132. doi: 10.1093/neuros/nyy155.

Measuring the Impact of Delayed Cerebral Ischemia on Neuropsychological Outcome After Aneurysmal Subarachnoid Hemorrhage-Protocol of a Swiss Nationwide Observational Study (MoCA-DCI Study).

Author information

1
Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Switzerland.
2
Department of Neurosurgery, University Hospital Berne, Berne, Switzerland.
3
Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland.
4
Department of Neurosurgery, University Hospital Basel, Basel, Switzerland.
5
Department of Neurosurgery, University Hospital Lausanne, Lausanne, Switzerland.
6
Department of Neurosurgery, Ente Ospedaliero Cantonale, Lugano, Switzerland.
7
Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
8
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
9
Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
10
Neuropsychology Unit, Department of Neurology, University Hospital Berne, Berne, Switzerland.
11
Neuropsychology Unit, Department of Neurology, University Hospital Geneva, Geneva, Switzerland.
12
Neuropsychology Unit, Department of Neurology, Memory Clinic Basel, Basel, Switzerland.
13
Neuropsychology Unit, Department of Neurology, University Hospital Lausanne, Lausanne, Switzerland.
14
Neuropsychology Unit, Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland.
15
Neuropsychology Unit, Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
16
Neuropsychology Unit, Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland.
17
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia.

Abstract

BACKGROUND:

The exact relationship between delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) and neuropsychological impairment remains unknown, as previous studies lacked a baseline examination after aneurysm occlusion but before the DCI-period. Neuropsychological evaluation of acutely ill patients is often applied in a busy intensive care unit (ICU), where distraction represents a bias to the obtained results.

OBJECTIVE:

To evaluate the relationship between DCI and neuropsychological outcome after aSAH by comparing the Montreal Cognitive Assessment (MoCA) results in aSAH patients with and without DCI at 3 mo with a baseline examination before the DCI-period (part 1). To determine the reliability of the MoCA, when applied in an ICU setting (part 2).

METHODS:

Prospective, multicenter, and observational study performed at all Swiss neurovascular centers. For part 1, n = 240 consecutive aSAH patients and for part 2, n = 50 patients with acute brain injury are recruited.

EXPECTED OUTCOMES:

Part 1: Effect size of the relationship between DCI and neuropsychological outcome (MoCA). Part 2: Reliability measures for the MoCA.

DISCUSSION:

The institutional review boards approved this study on July 4, 2017 under case number BASEC 2017-00103. After completion, the results will be offered to an international scientific journal for peer-reviewed publication. This study determines the exact impact of DCI on the neuropsychological outcome after aSAH, unbiased by confounding factors such as early brain injury or patient-specific characteristics. The study provides unique insights in the neuropsychological state of patients in the early period after aSAH.

KEYWORDS:

Cognitive disorders; Delayed cerebral ischemia; Montreal Cognitive Assessment; Outcome; Reliability; Stroke; Subarachnoid hemorrhage

PMID:
29762759
DOI:
10.1093/neuros/nyy155

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