Cognitive Impairments After Clipping of Ruptured Anterior Circulation Aneurysms Manju Mohanty 1 , Sivashanmugam Dhandapani 1 , Sunil Kumar Gupta 1 , Adnan Hussain Shahid 1 , Devi Prasad Patra 2 , Anchal Sharma 3 , Suresh N. Mathuriya 1 - BACKGROUND: The cognitive impairments after treat- ment of ruptured aneurysms have often been under- estimated. This study sought to assess their prevalence and analyze various associated factors. - METHODS: Patients who were operated on for ruptured anterior circulation aneurysms and discharged with a Glasgow Outcome Scale score of 4e5 were studied at 3 months for various cognitive impairments. Continuous scales of memory (recent, remote, verbal, visual, and overall memory), verbal fluency (phonemic and category fluency), and others were studied in relation to various factors. Univariate and multivariate analyses were per- formed using SPSS version 21. - RESULTS: A total of 87 patients were included in our study. Phonemic fluency was the most affected, noted in 66% of patients. Although 56% had some memory-related impair- ments, 13 (15%) and 6 (7%) had moderate and severe deficits in recent memory and 19 (22%) and 12 (14%) had moderate and severe deficits in remote memory, respectively. Patients operated on for anterior cerebral artery (ACA) aneurysms had significantly greater impairments in recent (34% vs. 8%) and remote memory (43% vs. 28%) compared with the rest, both in univariate (P [ 0.01 and 0.002, respectively) and multivariate analyses (P [ 0.01 and 0.03, respectively). ACA-related an- eurysms also had significantly greater independent impair- ments in phonemic fluency (P [ 0.04), compared with others. The clinical grade had a significant independent impact only on remote memory (P [ 0.01). - CONCLUSIONS: Cognitive impairments are frequent af- ter treatment of ruptured anterior circulation aneurysms. Impairments in recent memory, remote memory, and pho- nemic fluency are significantly greater after treatment of ACA-related aneurysms, compared with others, indepen- dent of other factors. INTRODUCTION A neurysmal subarachnoid hemorrhage (SAH) is a life- threatening illness that affects people suddenly and without warning and occurs at a relatively young age. Only 50% of people who experience SAH survive. Among the survivors, about 50% of the patients have permanent disability and are un- able to resume the premorbid level of functioning. 1-3 Cognitive impairments in the domains of attention, executive functions, memory, and language are frequently reported among the survivors even in patients with good neurologic outcome. 1-5 Although these deficits are more prominent during the first 3 months, 6 a few studies have reported their persistence even at longer intervals. 7-9 The cognitive impairments have a significant impact on the rehabilitation process, socioeconomic burden, and occupational reintegration. 10-12 Several attempts have been made to explore the factors asso- ciated with cognitive impairment. 13-15 Neuropsychological tests can detect residual disabilities that are not evident on traditional Glasgow Outcome Scale (GOS) measures. The delayed subclinical toxic effects of the blood products in the subarachnoid space also act diffusely on the cerebral cortex without producing focal brain Key words - ACOM/DACA aneurysm - Aneurysmal subarachnoid hemorrhage - Cognitive impairments - GOS - Neuropsychological tests Abbreviations and Acronyms ACA: Anterior cerebral artery ACOM: Anterior communicating artery DACA: Distal anterior cerebral artery GOS: Glasgow Outcome Scale DSST : Digit Symbol Substitution Test SAH: Subarachnoid hemorrhage WFNS: World Federation of Neurosurgical Societies From the 1 Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India; 2 Department of Neurosurgery, Louisiana State University HSC, Shreveport, Louisiana, USA; and 3 Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India To whom correspondence should be addressed: Manju Mohanty, Ph.D. [E-mail: manjumohanty2011@gmail.com] Citation: World Neurosurg. (2018). https://doi.org/10.1016/j.wneu.2018.06.048 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Published by Elsevier Inc. WORLD NEUROSURGERY -: e1-e8, - 2018 www.WORLDNEUROSURGERY.org e1 Original Article