title: Predicting return to work after subarachnoid hemorrhage using the Montreal Cognitive Assessment (MoCA).
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 %.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neuroscience, Section of Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden. svante.wallmark@gmail.com.
authors.forename: Svante
authors.initials: S
authors.lastname: Wallmark
authors.affiliation: Department of Neuroscience, Section of Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ronne-Engström
authors.affiliation: Department of Neuroscience, Section of Neurology, Uppsala University, Uppsala, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Lundström
mesh_terms: D000368:Aged; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D062707:Return to Work / Q000523:psychology* / Q000706:statistics & numerical data*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000523:psychology* / Q000601:surgery; D016896:Treatment Outcome
keywords: Aneurysmal; Cognitive impairment; Cognitive symptoms; Return to work; Subarachnoid hemorrhage; Work capacity