J Neurol Surg A Cent Eur Neurosurg 2015; 76 - P006
DOI: 10.1055/s-0035-1564509

Call for Uniform Psychosocial Assessment after Aneurysmal Subarachnoid Hemorrhage: Swiss Recommendations

M. N. Stienen 1, A. Zweifel-Zehnder 2, C. Chicherio 3, A. Studerus-Germann 4, S. Bläsi 5, S. Rossi 6, K. Gutbrod 7, N. Schmid 8, V. Beaud 9, C. Mondadori 10, P. Brugger 11, L. Sacco 6, R. Müri 7, G. Hildebrandt 12, J. Y. Fournier 12, E. Keller 13, L. Regli 13, J. Fandino 14, L. Mariani 15, A. Raabe 16, R. T. Daniel 17, M. Reinert 18, T. Robert 18, B. Schatlo 19, P. Bijlenga 1, K. Schaller 1, A. U. Monsch 5
  • 1Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland
  • 2Division of Neuropediatrics, Development, and Rehabilitation, Department of Pediatrics, Inselspital Bern, Bern, Switzerland
  • 3Department of Neurology, Neuropsychology Unit, University Hospital Geneva, Geneva, Switzerland
  • 4Neuropsychology Unit, Department of Neurology, Kantonsspital St. Gallen, St.Gallen, Switzerland
  • 5Memory Clinic, University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland
  • 6Department of Neurology, Neuropsychology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
  • 7Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital Bern, Bern, Switzerland
  • 8Neuropsychology Unit, Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
  • 9Neuropsychology Unit, Department of Neurology, CHUV, Lausanne, Switzerland
  • 10Neurological Rehabilitation, Rehaklinik Bellikon, Bellikon, Switzerland
  • 11Neuropsychology Unit, Department of Neurology, University Hospital Zürich, Zürich, Switzerland
  • 12Department of Neurosurgery, Kantonsspital St. Gallen, St.Gallen, Switzerland
  • 13Department of Neurosurgery, University Hospital Zürich, Zürich, Switzerland
  • 14Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
  • 15Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
  • 16Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
  • 17Department of Neurosurgery, CHUV, Lausanne, Switzerland
  • 18Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
  • 19Department of Neurosurgery, Georg-August University, University Medicine Göttingen, Göttingen, Germany

Background: In a high proportion of patients with favorable outcome after aneurysmal subarachnoid hemorrhage (aSAH), neuropsychological deficits (NPD), depression, anxiety, and fatigue are responsible for the inability to return to their regular premorbid life and pursue their professional career. These problems often remain unrecognized, as no recommendations concerning a standardized comprehensive assessment have yet found entry into clinical routine. Methods: To establish a nationwide standard concerning a comprehensive assessment after aSAH, representatives of all neuropsychological and neurosurgical departments of those eight Swiss centers treating acute aSAH have agreed on a common protocol. In addition, a battery of questionnaires and neuropsychological tests was developed, optimally suited to the deficits found most prevalent in aSAH patients that was available in different languages (i.e., German, French, Italian, and English) and standardized. Results: We propose a baseline inpatient neuropsychological screening using the Montreal Cognitive Assessment (MoCA) between days 14 and 28 after aSAH to evaluate the need for a stationary rehabilitation. In an outpatient setting, we recommend a detailed assessment capturing anxiety, depression, fatigue, symptoms of frontal lobe affection, and quality of life. In addition, a neuropsychological examination, testing all relevant domains including attention, speed of information processing, executive functions, verbal and visual learning/memory, language, visuo-perceptual abilities, and premorbid intelligence, should be performed at 3 and 12 months after the bleeding (Fig. 1). Please find detailed information on inclusion/exclusion criteria, the exact selection of questionnaires, and the neuropsychological test battery in Tables 1 to 3. Conclusion: The introduction of a standardized neuropsychological assessment into clinical routine will lead to a more comprehensive assessment of the patient and facilitate the detection and subsequent treatment of previously unrecognized but relevant impairments. The implementation of the neuropsychological data into a nationwide scientific collaboration is of great value to determine the incidence, characteristics, modifiable risk factors, and the clinical course of neuropsychological deficits after aSAH.