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Cognitive, Physical, and Psychological Status After Intracranial Aneurysm Rupture: A Cross-Sectional Study of a Stockholm Case Series 1996 to 1999
Red Cross University College of Nursing. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
2013 (English)In: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 79, no 1, 130-135 p.Article in journal (Refereed) Published
Abstract [en]

Objective

We sought to (1) describe psychological, physical, and cognitive functions in patients 10 years after intracranial aneurysm rupture and (2) identify any differences in outcome variables between age groups, gender or aneurysm locations.

Methods

A consecutive sample of patients (n = 217) treated for intracranial aneurysm rupture at a neurosurgical clinic in Stockholm, Sweden, were followed-up in a cross-sectional design 10.1 years after the onset with questionnaires and telephone interviews. The outcome measures were psychological functions in terms of symptoms of anxiety or depression and physical and cognitive functions.

Results

Compared with the reference groups, the aneurysm patients scored greater levels of anxiety and depression than normal values. Patients with aneurysm rupture in the posterior circulation scored significantly more problems with anxiety and depression. Only 2.8% of the patients scored for severe physical disability. On a group level, cognition was lower than normal population levels; 21.7% of respondents scored below the cut-off value, indicating cognitive impairments.

Conclusions

Ten years after aneurysm rupture the majority of patients seem to be well-functioning physically, whereas the psychological and cognitive functions are affected. A screening of the mental health of these patients in connection to radiological follow-up might be helpful to identify which patients need further referral to psychiatric treatment for anxiety and depression disorders.

Place, publisher, year, edition, pages
Elsevier, 2013. Vol. 79, no 1, 130-135 p.
Keyword [en]
activities of daily living, anxiety, cognition, depression, intracranial aneurysm, long-term survivors, subarachnoid hemorrhage
National Category
Nursing
Identifiers
URN: urn:nbn:se:rkh:diva-499DOI: 10.1016/j.wneu.2012.03.032PubMedID: 22484070OAI: oai:DiVA.org:rkh-499DiVA: diva2:606536
Note

Som manuskript i avhandling. As manuscript in dissertation

Available from: 2013-02-19 Created: 2013-02-19 Last updated: 2014-11-07Bibliographically approved
In thesis
1. Impact on life after intracranial aneurysm rupture: health-related quality of life and epidemiologic outcomes
Open this publication in new window or tab >>Impact on life after intracranial aneurysm rupture: health-related quality of life and epidemiologic outcomes
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe impact on life up to ten years after intracranial aneurysm rupture in terms of health-related quality of life, changes in everyday life and descriptive epidemiology with the intention to contribute to an increased understanding of the long-term perceived consequences of that impact.

Study I aimed to describe changes and transitions in everyday life during the first two years following an intracranial aneurysm rupture. A consecutive sample of 88 patients was followed-up at three time points. A majority of respondents perceived changes in their everyday life during the first two years following aneurysm rupture. Transitions were revealed within changes in personality, changed social roles and relationships, and changed abilities and behavior.

In Study II epidemiology in relation to gender differences and treatment modalities ten years after aneurysm rupture was investigated. Ten years after the onset, 63.9% of the 468 admitted patients were still alive. The incidence in women was higher than that of men; they were older at onset and were diagnosed with more aneurysms. There were no significant differences in survival times between patients treated with different active aneurysm treatments, or between men and women.

In Study III survivors from study II (n=217) were followed-up with questionnaires and telephone interviews, aiming to describe psychological, physical and cognitive functions ten years after intracranial aneurysm rupture. Compared to reference groups, the aneurysm respondents scored higher levels of anxiety and depression. Respondents with ruptured aneurysms in the posterior circulation of the brain scored significantly more symptoms of anxiety and depression. A small proportion, 2.8%, scored for severe physical disability and 21.7% scored below the cut-off value, indicating cognitive impairments.

Study IV used the same sample as study III (n=217), and a general population sample (n=434) from the Stockholm Public Health Survey, matched by age and sex. The aim was to measure health-related quality of life (HRQoL), and to explore factors affecting HRQoL, ten years after intracranial aneurysm rupture. Compared to general population, the aneurysm sample reported significantly more problems with mobility, self-care, usual activities and anxiety/depression and had significantly lower overall HRQoL values. HRQoL in the aneurysm sample was most affected in respondents with worse neurological outcome, respondents with comorbidities, and respondents with low perceived recovery.

In conclusion, intracranial aneurysm ruptures impacts upon life in several ways for an extensive period of time after the onset. The results indicate a need for follow-up and support, and to identify subgroups of aneurysm patients who might benefit from support: patients with ruptured aneurysms in the posterior circulation of the brain; patients with worse neurological outcome at hospital discharge; patients with comorbidities; and patients with low perceived recovery. Ten years after the onset of aneurysm rupture the majority of patients were still alive. Differences between men and women were apparent in incidence and clinical presentation at the onset of aneurysm rupture, not in survival times. Survival time was equal between patients within active treatment modalities.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2012. 70 p.
Keyword
intracranial aneurysm rupture, quality of life
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-701 (URN)978-91-7457-927-7 (ISBN)
Public defence
2012-12-14, Kugelbergsalen, Karolinska Universitetssjukhuset, Solna, 14:00
Opponent
Supervisors
Available from: 2014-09-17 Created: 2013-08-01 Last updated: 2014-09-17Bibliographically approved

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Citation style
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