DOI: https://doi.org/10.15587/2313-8416.2015.42987

Cognitive disorders in patients with deep disability after surgery on intracranial aneurysmal hemorrhage

Світлана Олександрівна Дудукіна, Світлана Олександрівна Алексюк, Олександр Миколайович Толубаєв

Abstract


The characteristics of cognitive impairment in patients with deep disability after surgery on intracranial aneurysmal hemorrhage almost aren’t identified.

Aim. To determine the state of cognitive functions in patients with severe disability after surgery on intracranial aneurysmal hemorrhage.

Methods. The study included 328 patients with intracranial aneurysmal hemorrhages. 257 patients underwent intracranial surgery - arterial aneurysm clipping, 71 patients are operated by endovascular method. Immediate responses to the treatment are assessed at the end of inpatient treatment and 6 months after discharge on a scale of consequences Glasgow (GOS). Late results of the treatment were assessed by the modified Rankin scale 2.5 years after surgery. Deep disability status of patients is considered for GOS-2 (persistent vegetative state) or 3 points (severe disability) and for Rankin - 4 (Moderately severe disability) or 5 points (Severe disability). Cognitive impairment and ability to communicate was assessed using the MMSE scale.

Result. Quality of life in patients with deep disability changed over time. Immediately after surgery the average score for the MMSE amounted to 10.3 points, 6 months – 13.6, 2.5 years – 21.8. Violation of a guide at the time and place was much pronounced almost the entire time of observation. The function of the perception of information 2.5 years after surgery fully recovered in 72 % of patients. Only in 6 months after surgery 100% of patients with deep disability were dysfunction of concentration and arithmetic. This function completely restored only 2.5 years after surgery in 28 % of patients. The largest number of patients who completely regenerated memory function was observed 2.5 years after surgery. After 2.5 years of observation in 12 % of patients was observed a complete regeneration of reading function. Realization of three-phase commands in most patients remained broken in all time of observation.

Conclusions. Despite the presence of significant neurological deficits and dependence on others, general condition of cognitive functions within 2.5 years after surgery in patients with deep disability after surgery on intracranial aneurysmal hemorrhage is improved. Patients with deep disability after surgery on intracranial aneurysmal hemorrhages it is observe violation of all cognitive functions measured on MMSE scale. The most problematic in terms of restoring is function of realization of three-phase command


Keywords


intracranial aneurysmal hemorrhage; surgery; cognitive functions; deep disability

References


Ogden, J. A., Utley, T., Mee, E. W. (1997). Neurological and Psychosocial Outcome 4 to 7 Years after Subarachnoid Hemorrhage. Neurosurgery, 41 (1), 25–34. doi: 10.1097/00006123-199707000-00008

Al-Khindi, T., Macdonald, R. L., Schweizer, T. A. (2010). Cognitive and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage. Stroke, 41 (8), 519–536. doi: 10.1161/strokeaha.110.581975

Chahal, N., Barker-Collo, S., Feigin, V. (2011). Cognitive and Functional Outcomes of 5-Year Subarachnoid Haemorrhage Survivors: Comparison to Matched Healthy Controls. Neuroepidemiology, 37 (1), 31–38. doi: 10.1159/000328647

Nasledov, A. (2011). SPSS 19: professional'nyj statisticheskij analiz dannyh. SPb.: Piter, 400.

Proust, F., Martinaud, O., Gérardin, E., Derrey, S., Levèque, S., Bioux, S. et. al. (2009). Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment. Journal of Neurosurgery, 110 (1), 19–29. doi: 10.3171/2008.3.17432

Frazer, D., Ahuja, A., Watkins, L., Cipolotti, L. (2007). Coiling versus clipping for the treatment of aneurysmal subarachnoid hemorrhage. Neurosurgery, 60 (3), 434–442. doi: 10.1227/01.neu.0000255335.72662.25

Folstein, M. F., Folstein, S. E., McHugh, P. R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12 (3), 189–198.


GOST Style Citations


1. Ogden, J. Neurological and psychological outcome 4 to 7 years after subarachnoid hemorrhage [Text] / J. Ogden, T. Utley, E. W. Mee // Neurosurgery. – 1997. – Vol. 41, Issue 1. – P. 25–34. doi: 10.1097/00006123-199707000-00008 

2. Al-Khindi, T. Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage [Text] / T. Al-Khindi, R. L. Macdonald, T. A. Schweizer // Stroke. – 2010. – Vol. 41, Issue 8. – P. 519–536. doi: 10.1161/strokeaha.110.581975 

3. Chahal, N. Cognitive and functional outcomes of 5-year subarachnoid haemorrhage survivors: comparison to matched healthy controls [Text] / N. Chahal, S. Barker-Collo, V. Feigin // Neuroepidemiology. – 2011. – Vol. 37, Issue 1. – Р. 31–38. doi: 10.1159/000328647 

4. Наследов, А. SPSS 19: профессиональный статистический анализ данных [Текст] / А. Наследов. – СПб.: Питер, 2011. – 400 с.

5. Proust, F. Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment [Text] / F. Proust, O. Martinaud, E. Gérardin, S. Derrey, S. Levèque, S. Bioux et. al. // Journal of Neurosurgery. – 2009. – Vol. 110. – P. 19–29. doi: 10.3171/2008.3.17432 

6. Frazer, D. Coiling versus clipping for the treatment of aneurysmal subarachnoid hemorrhage: a longitudinal investigation into cognitive outcome [Text] / D. Frazer, A. Ahuja, L. Watkins, L. Cipolotti // Neurosurgery. – 2007. – Vol. 60, Issue 3. – P. 434–442. doi: 10.1227/01.neu.0000255335.72662.25 

7. Folstein, M. F. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician [Text] / M. F. Folstein, S. E. Folstein, P. R. McHugh // Journal of psychiatric research. – 1975. – Vol. 12, Issue 3. – P. 189–198.







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