title: Decision-making deficits persist after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Effective decision-making is critical for resuming day-to-day activities after aneurysmal subarachnoid hemorrhage (aSAH). Little is known, however, about how decision-making is affected after aSAH, particularly under ambiguous conditions in which neither the outcome nor the outcome probabilities are known.
  
  
  METHODS
  Here we examined the integrity of decision-making under ambiguity in a cohort of aSAH patients classified as having made a "good outcome" according to the Glasgow Outcome Scale. Thirty aSAH survivors and 33 healthy controls completed the Iowa Gambling Task (IGT) and the Balloon Analogue Risk Task (BART). Mean time of assessment poststroke was 30 months.
  
  
  RESULTS
  Although patients and controls had similar decision-making strategies on the IGT, patients made significantly fewer switches between decks, suggesting perseveration and cognitive inflexibility. On the BART, aSAH patients demonstrated significantly enhanced risk-taking behavior relative to controls. Examination of effect sizes revealed cognitive inflexibility in 33% to 35% of aSAH patients and enhanced risk-taking behavior in 35% to 40% of aSAH patients.
  
  
  CONCLUSIONS
  Approximately one third of "good outcome" aSAH patients experience cognitive inflexibility and enhanced risk-taking behavior over 2 years poststroke, illustrating the persistence of aSAH-associated cognitive impairment.
authors.affiliation: Johns Hopkins University School of Medicine.
authors.forename: Timour
authors.initials: T
authors.lastname: Al-Khindi
authors.affiliation: Division of Neurosurgery, St. Michael's Hospital.
authors.forename: R Loch
authors.initials: RL
authors.lastname: Macdonald
authors.affiliation: Division of Neurosurgery, St. Michael's Hospital.
authors.forename: Tom A
authors.initials: TA
authors.lastname: Schweizer
mesh_terms: D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000523:psychology*; D035501:Uncertainty