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Life after Subarachnoid Hemorrhage
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.ORCID iD: 0000-0002-2864-0259
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease with mean age of 59 years. SAH accounts for 5% of all stroke and more than one quarter of potential life years lost through stroke. With the advanced neurosurgical methods of today two thirds of the patients survive. We know, however, that various cognitive, psychiatric and physical impairments are common that affect quality of life, social life, and the ability to work in the aftermath of SAH. The overall aim constituting this PhD dissertation is to better understand some of the challenges often faced by those surviving SAH.

Two SAH patient cohorts have been studied. The first followed 96 consecutively included patients during the first year after ictus. Spasticity and cognitive impairment was assessed after 6 months and the Swedish stroke register follow-up form was used to investigate family support and the use of medical and social services. Return to work was assessed at 12 months. The second cohort assessed attention deficits using the test of variables of attention (T.O.V.A.) at 7 months after ictus in 19 patients with moderate to good recovery.

Spasticity was just as common in our SAH patients as after other stroke, though it was rarely treated pharmacologically. By assessing cognitive impairment at 6 months after ictus using the Montreal cognitive assessment, 68% of the patients could be correctly predicted as having returned/not returned to work at 12 months. Seventeen percent of the patients had not had a follow-up appointment 6 months after ictus. These patients were older, more often living alone, had a lower quality of life, more depressive symptoms and more cognitive impairment compared to those having had a follow-up appointment. Twenty percent had had a follow-up in primary care. Seventy-eight percent of those with moderate to severe disability were living in their own accommodations. Fifty-eight percent of the patients had attention deficits. Challenges after SAH were common and often dealt with in the home environment of the patients.

The results of this thesis highlight the importance of assisting the patients and their relatives in their struggle back to life after SAH.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , p. 97
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1281
Keywords [en]
Aneurysmal, Attention deficit, Cognitive impairment, Family medicine, Follow-up appointments, General practice, Intracranial aneurysm, Outcome, Primary care, Primary health care, Return to work, Spasticity, Stroke, Subarachnoid hemorrhage, Sweden
National Category
Neurology
Research subject
Neurosurgery
Identifiers
URN: urn:nbn:se:uu:diva-307949ISBN: 978-91-554-9762-0 (print)OAI: oai:DiVA.org:uu-307949DiVA, id: diva2:1049535
Public defence
2017-01-13, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2016-12-20 Created: 2016-11-23 Last updated: 2016-12-20
List of papers
1. Prevalence of spasticity after aneurysmal subarachnoid haemorrhage
Open this publication in new window or tab >>Prevalence of spasticity after aneurysmal subarachnoid haemorrhage
2014 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 1, p. 23-27Article in journal (Refereed) Published
Abstract [en]

Objective: The prevalence of spasticity after stroke is approximately 20%. There is, so far, little information in the literature on the development of spasticity after aneurysmal subarachnoid haemorrhage. The objectives of this study were to estimate the prevalence of spasticity after aneurysmal subarachnoid haemorrhage and to identify possible risk factors in the acute phase. Methods: A total of 87 patients were assessed for spasticity with the Modified Ashworth Scale after 6 months. A multivariate logistic regression model was used to evaluate risk factors. Results: Spasticity was present after 6 months in 19 (22%) of the patients, but was treated pharmacologically in only 1 case. Worse clinical status at admission carried a high risk for spasticity (odds ratio (OR) 10.2; 95% confidence interval (CI) 2.4-43.2), followed by the presence of infection (OR 7.4; 95% CI 1.6-33.8) and vasospasm (OR 4.8; 95% CI 1.2-19.0) during the intensive care phase. Conclusion: Spasticity after aneurysmal subarachnoid haemorrhage occurred with the same prevalence as after other stroke. Risk factors for spasticity were worse clinical condition at admission and the occurrence of infection and vasospasm during the intensive care period. Pharmacological treatment was not commonly used.

National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-218699 (URN)10.2340/16501977-1229 (DOI)000330421800004 ()24201997 (PubMedID)
Available from: 2014-02-14 Created: 2014-02-14 Last updated: 2018-06-28
2. Predicting return to work after subarachnoid hemorrhage using the Montreal Cognitive Assessment (MoCA)
Open this publication in new window or tab >>Predicting return to work after subarachnoid hemorrhage using the Montreal Cognitive Assessment (MoCA)
2016 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 158, no 2, p. 233-239Article in journal (Refereed) Published
Abstract [en]

Returning to work is a major issue for patients having had an aneurysmal subarachnoid hemorrhage (SAH). It is important, at an early stage, to identify the patients that are unlikely to return to work. The objective of this study was to assess the predictive value of the Montreal Cognitive Assessment (MoCA) at 6 months after ictus on return to work at 12 months. In this prospective study were 96 patients with SAH included in the acute phase. Cognitive functions were assessed at 6 months using the MoCA and return to work at 12 months. The predictive value of MoCA on return to work was analyzed using the area under the receiver operating characteristic curve as well as logistic regression. Of those that had work before the SAH, 52 % were working at 12 months after the ictus. These patients had scored significantly better on MoCA at 6 months (p = 0.01). The area under the receiver operating characteristic curve was 0.75. By using a cut-off on MoCA of < 27, 68 % of the patients could be correctly classified as returned/not returned to work. Adding data from the acute phase to the MoCA in a logistic regression model increased the percentage of patients correctly classified as returned/not returned to work by 2 %. Returning to work is a major issue for SAH patients. It is important to identify factors that may interfere with a patient's ability to return to work, and address these issues appropriately. In our study, estimating cognitive functions at 6 months after SAH using the MoCA alone allowed us to predict return to work correctly in 68 % of the cases. We feel that this provides useful information in planning rehabilitation, but that other post-SAH symptoms have to be considered as well.

Keywords
Subarachnoid hemorrhage, Aneurysmal, Cognitive symptoms, Cognitive impairment, Work capacity, Return to work
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-277979 (URN)10.1007/s00701-015-2665-4 (DOI)000368603400004 ()26676517 (PubMedID)
Available from: 2016-03-02 Created: 2016-02-23 Last updated: 2018-06-28
3. Contact with medical and social services after the acute phase of subarachnoid hemorrhage
Open this publication in new window or tab >>Contact with medical and social services after the acute phase of subarachnoid hemorrhage
(English)Manuscript (preprint) (Other academic)
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-307376 (URN)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2016-11-24
4. Attention Deficits After Aneurysmal Subarachnoid Hemorrhage Measured Using the Test of Variables of Attention
Open this publication in new window or tab >>Attention Deficits After Aneurysmal Subarachnoid Hemorrhage Measured Using the Test of Variables of Attention
2015 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 46, no 5, p. 1374-1376Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE:

The aim of this pilot study was to assess attention deficits in patients with aneurysmal subarachnoid hemorrhage using the test of variables of attention (TOVA). This is a computer-based continuous performance test providing objective measures of attention. We also compared the TOVA results with the attention and concentration domains of Montgomery Åsberg Depression Rating Scale and Montreal cognitive assessment, 2 examiner-administrated neuropsychological instruments.

METHODS:

Nineteen patients with moderate to good recovery (Glasgow outcome scale, 4-5) were assessed using the TOVA, Montgomery Åsberg Depression Rating Scale, and Montreal cognitive assessment. The measurements were done when the patients visited the hospital for a routine magnetic resonance imaging control of the aneurysm.

RESULTS:

TOVA performance was pathological in 58%. The dominating pattern was a worsening of performance in the second half of the test, commonly a failing to react to correct stimuli. We found no correlation between TOVA and the performance in concentration and attention domains of Montgomery Åsberg Depression Rating Scale and Montreal cognitive assessment.

CONCLUSIONS:

Attention deficits, measured by the TOVA, were common after subarachnoid hemorrhage. This should be further studied to improve outcome.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-248055 (URN)10.1161/STROKEAHA.115.009092 (DOI)000353559800054 ()25791712 (PubMedID)
Available from: 2015-03-26 Created: 2015-03-26 Last updated: 2018-06-28

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