title: Long-term domain-specific improvement following poor grade aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  While efforts have been made to document short-term outcomes following poor grade aneurysmal subarachnoid hemorrhage (aSAH), no data exist concerning the degree of delayed improvement in neurological function. Here we assess cognitive function, level of independence, and quality of life (QoL) over 12 months following poor grade aSAH.
  
  
  METHODS
  Data on definitively treated poor grade patients (Hunt and Hess grade IV or V) surviving 12 months post-aSAH were obtained through a prospectively maintained SAH database. Demographic information, medical history, and clinical course were analyzed. Health outcomes assessments completed by surviving patients at discharge (DC), three months (3 M) and 12 months (12 M) follow-up, including the Telephone Interview for Cognitive Status (TICS), Barthel Index (BI), and Sickness Impact Profile (SIP), were used to evaluate cognitive function, level of independence, and QoL.
  
  
  RESULTS
  Fifty-six poor grade patients underwent aneurysm-securing intervention and survived at least 12 months post-aSAH. Thirty-five (63%) surviving patients underwent health outcomes assessments at DC, 3 M and 12 M post-aSAH. A majority of patients had improved scores on the TICS (DC to 3 M: 91%; 3 M to 12 M: 82%), BI (DC to 3 M: 96%; 3 M to 12 M: 92%), and SIP (3 M to 12 M: 80%) following aSAH. Using paired-sample analyses, significant improvement on each test was observed.
  
  
  CONCLUSIONS
  A substantial portion of patients experience cognitive recovery, increased independence, and improved QoL following poor grade aSAH. Delayed follow-up assessments are necessary when evaluating functional recovery in this population. These findings have the potential to impact poor grade aSAH management and prognosis.
authors.affiliation: Department of Neurological Surgery, Columbia University, New York, NY 10032, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.forename: Evan R
authors.initials: ER
authors.lastname: Ransom
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Komotar
authors.forename: Paulina B
authors.initials: PB
authors.lastname: Sergot
authors.forename: Noeleen
authors.initials: N
authors.lastname: Ostapkovich
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.forename: Kurt T
authors.initials: KT
authors.lastname: Kreiter
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011788:Quality of Life; D018434:Sickness Impact Profile; D013345:Subarachnoid Hemorrhage / Q000523:psychology / Q000628:therapy*; D013689:Telephone; D014057:Tomography, X-Ray Computed