Patricia E C A Passier

Prevalence and Determinants of Cognitive Complaints after Aneurysmal Subarachnoid Hemorrhage

Background: To investigate the prevalence of cognitive complaints after subarachnoid hemorrhage (SAH) and the relationships between cognitive complaints and cognitive impairments, disability and emotional problems. Methods: Cognitive complaints were assessed with the Checklist for Cognitive and Emotional Consequences following stroke (CLCE-24) in 111 persons who visited our outpatient clinic 3 months after SAH. Associations between cognitive complaints and cognitive functioning, demographic characteristics, disability and emotional problems were examined using Spearman correlations and linear regression analysis. Results: In this study group, 105 patients (94.6%) reported at least one cognitive or emotional complaint that hampered everyday functioning. The most frequently reported cognitive complaints were mental slowness, short-term memory problems and attention deficits. All cognitive domains, disability, depressive symptoms and feelings of anxiety were significantly associated with the CLCE-24 cognition score. In the final regression model, memory functioning (β value –0.21), disability (–0.28) and depressive symptoms (0.40) were significant determinants of cognitive complaints, together explaining 35.4% of the variance. Conclusion: Cognitive complaints are common after SAH and associated with memory deficits, disability and depressive symptoms. Rehabilitation programs should focus on these symptoms and deficits.

Life Satisfaction and Return to Work After Aneurysmal Subarachnoid Hemorrhage

This study was conducted to investigate life satisfaction and employment status after aneurysmal subarachnoid hemorrhage (SAH) and to explain the associations between life satisfaction and demographic, disease-related, psychological, and personality characteristics. Subjects with SAH (n = 141) living at home 2-4 years after the SAH responded to a mailed questionnaire. Outcomes were life satisfaction, as measured with the Life Satisfaction Questionnaire 9 (LiSat-9), and employment status. Determinants in multiple regression analysis were demographic and SAH characteristics, subjective complaints (eg, mood disorder, fatigue, cognitive complaints), and personality characteristics (eg, neuroticism, passive coping style). Of the 141 subjects, 64 (46.7%) had a Glasgow Outcome Scale score of V (good outcome) at discharge. Mean subject age was 51.4 ± 12.3 years, and mean time after SAH was 36.1 ± 7.9 months. Of the 88 subjects who were working at the time of the SAH, 54 (61.4%) returned to work, but only 31 (35.2%) resumed their work completely. The subjects were least satisfied with their vocational situation (51.9% satisfied) and sexual life (51.7%) and were most satisfied with their relationships (75.2%-88.7%) and self-care ability (88.6%). Age (β value = 0.17), return to work after SAH (0.19), disability at hospital discharge (0.25), worsened mood (-0.37), and passive coping (-0.25) together accounted for 47.2% of the life satisfaction scores. Our data indicate that return to work is a major issue for individuals who survive an SAH. Not returning to work, disability, depression, and passive coping are associated with reduced life satisfaction. Thus, vocational reintegration after SAH merits more attention during rehabilitation.

Development and validation of a short version of the Stroke Specific Quality of Life Scale

Background and purpose The Stroke Specific Quality of Life Scale (SS-QoL) is a well validated measure of health related quality of life in patients with stroke, but with 49 items its length is a disadvantage. A short version of the SS-QoL was developed and tested here. Methods Secondary analyses of three different studies. The short version was developed using data from 141 patients with aneurysmal subarachnoid haemorrhage (SAH) and tested on data from independent samples of 97 patients with SAH and 105 patients with ischaemic stroke or intracerebral haemorrhage. The item with the highest item domain correlation from each of the SS-QoL domains was selected to obtain a 12 item SS-QoL (SS-QoL-12) with a total score and physical and psychosocial subscores. Criterion validity of the SS-QoL-12 scores was tested in each sample with the original SS-QoL as reference. Results All three scores of the SS-QoL-12 showed good internal consistency (Cronbachs alpha 0.77–0.89). The SS-Qol-12 scores predicted 88–95% of the variance of the original SS-QoL. Mean differences between the SS-QoL-12 and SS-QoL and their 95% CI were generally within 0.1 points on a 1–5 scale. The limits of agreement were generally within 0.4 points. Conclusion The SS-QoL-12 has good criterion validity for all subsets of stroke. Because it consists of only 12 questions, this short form will be easy to use in research and clinical settings.

Validation of the Stroke Specific Quality of Life scale in patients with aneurysmal subarachnoid haemorrhage

Background and purpose Disease specific quality of life measures have been validated for patients with ischaemic stroke and intracerebral haemorrhage, but not for patients with aneurysmal subarachnoid haemorrhage (SAH). The aim of this study was to validate the Stroke Specific Quality of Life (SS-QoL) scale for patients with SAH. Methods Cross sectional survey of 141 aneurysmal SAH patients. Construct and criterion validity were studied and various ways to merge the 12 SS-QoL domains into a limited number of subtotal scores were explored. Statistics included assessing score distributions, Cronbachs α, principal components analysis (PCA) and Spearman correlations between SS-QoL and the Glasgow Outcome Scale (GOS), Cognitive Failures Questionnaire (CFQ), Life Satisfaction-9 (LiSat-9) and Hospital Anxiety and Depression Scale (HADS). Results PCA revealed two components reflecting physical health and psychosocial health with a mutual correlation of 0.73. A ceiling effect was present for 10 out of 12 domains and for the physical component. Internal consistency was good for all 12 domains (α ≥0.80), two components (α ≥0.95) and the total score (0.97). Physical SS-QoL scores showed weak to moderate correlations (0.24–0.32) with the GOS. All SS-QoL scores showed moderate to strong correlations (0.35–0.72) with the CFQ, LiSat-9 and HADS. Conclusions The SS-QoL is a valid measure to assess quality of life in patients after aneurysmal SAH. Using physical and psychosocial SS-QoL summary scores simplifies the use of this measure without concealing differences in outcomes on different quality of life domains.

Post-Traumatic Stress Disorder in Patients 3 Years after Aneurysmal Subarachnoid Haemorrhage

Background: Subarachnoid haemorrhage (SAH) from a ruptured intracranial aneurysm accounts for approximately 5% of all strokes. Post-traumatic stress disorder (PTSD) is common in the early phase after recovery from aneurysmal SAH. The aim of our study was to examine the prevalence of PTSD 3 years after SAH, its predictors, and relationship with health-related quality of life (HRQoL) in patients living independently in the community. Methods: From a prospectively collected cohort of 143 patients with aneurysmal SAH who visited our outpatient clinic 3 months after SAH, 94 patients (65.7%) completed a mailed questionnaire 3 years after SAH. We assessed PTSD with the Impact of Event Scale and HRQoL with the Stroke-Specific Quality of Life Scale (SS-QoL). The χ2 and t tests were used to investigate if patients who returned the questionnaires were different from those who did not reply. Non-parametric tests (χ2 and Mann-Whitney tests) were used to test for differences between patients with and without PTSD. Relative risks and 95% confidence intervals were calculated. Results: No relevant differences in demographic (age, sex, education) or SAH characteristics (clinical condition on admission, complication, location of aneurysm, Glasgow Outcome Scale score at 3 months) were seen between participants and drop-outs. In 24 patients (26%), Impact of Event Scale scores indicated PTSD. Passive coping style (relative risk, 5.7; 95% confidence interval, 2.1-15.3), but none of the demographic or SAH-related factors, predicted PTSD. The mean SS-QoL total score was 4.2 (SD 1.1), indicative of a relatively satisfactory HRQoL. PTSD was associated with lower HRQoL (p < 0.001), a mean SS-QoL score of 4.4 (SD 1.0) without PTSD, and a mean SS-QoL score of 3.5 (SD 1.1) with PTSD. Conclusions: Even 3 years after SAH, 1 out of 4 patients had PTSD, which was associated with reduced HRQoL. Passive coping style was the most important predictor. There is a need to organize SAH care with more attention to and treatment of PTSD. Strategies shown to reduce PTSD in other conditions should be tested for effectiveness in SAH patients.

Longitudinal course of depressive symptoms and anxiety after aneurysmal subarachnoid hemorrhage

BACKGROUND Symptoms of anxiety and depression are present in almost half of the patients who survive an aneurysmal subarachnoid hemorrhage (aSAH), but the long-term course is unknown. AIM To study the longitudinal course and predictors of symptoms of anxiety and depression after aSAH. DESIGN Prospective longitudinal study with test occasions at 3 months (baseline), 1 year (T2) and 2-5 years (T3) post-aSAH. SETTING SAH outpatient clinic. POPULATION One hundred forty-three patients visiting the outpatient clinic. METHODS Patients visiting our outpatient clinic 3 months after aSAH and living independently in the community completed the Beck Depression Inventory-II-NL and the State-Trait Anxiety Inventory at 3 months (T1), one year (T2) and 2-5 years (T3). Potential predictors were collected at T1. RESULTS Complete datasets from 93 patients were analyzed. Depressive symptoms were present in 39% (T1), 41% (T2) and 54% (T3) of patients, symptoms of anxiety in 52% (T1), 48% (T2) and 53% (T3). Of patients with depressive symptoms at T1, 72% still had symptoms at T3, compared to 67% for anxiety. Disability on the Glasgow Outcome Scale (GOS), passive coping (UCL-PR) and depressive symptoms at T1 were significantly independent variables explaining 52% of the variance of depressive symptoms at T2. GOS and UCL-PR at T1 were variables explaining 25% of the variance of depressive symptoms at T3. Depressive symptoms and anxiety at T1 were predictive variables for anxiety at T2 (explained variance 43%) and UCL-PR for anxiety at T3 (explained variance 21%). CONCLUSIONS The prevalence of symptoms of depression and anxiety remained high during the first 2-5 years after aSAH. Passive coping at 3 months after aSAH was the most consistent predictor of symptoms of anxiety and depression in the long term. CLINICAL REHABILITATION IMPACT Since many patients who are initially free of symptoms of depression and anxiety develop such symptoms over time, we advocate screening for these symptoms and coping strategies to identify these patients and apply targeted therapy.

The prognostic value of neuropsychological examination after SAH

J.F. Penninx, J.M.A. Visser-Meily, P.E.C.A. Passier, G.J.E. Rinkel, M.W. Post M.J.E. Van Zandvoort Psychological Laboratory, Heimholtz Institute, Utrecht University, The Netherlands Rudolf Magnus Institute of Neuroscience, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands Rudolf Magnus Institute of Neuroscience and Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht and De Hoogstraat, Utrecht, The Netherlands