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Khosdelazad S, Spikman JM, Solvang S, Wermer MJH, Pender N, Jorna LS, Rakers SE, van der Hoorn A, Javadpour M, Groen RJM, Buunk AM. Re-evaluating patient communication and care in angiographically negative subarachnoid hemorrhage: Balancing realism and optimism. Eur J Neurol 2024:e16257. [PMID: 38491735 DOI: 10.1111/ene.16257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/18/2024]
Abstract
Angiographically negative subarachnoid hemorrhage (anSAH) has traditionally been considered a benign condition, mainly because of favorable outcomes in the acute stage in comparison to the often negative acute outcomes of aneurysmal subarachnoid hemorrhage. However, a growing body of research in recent years shows that anSAH often leads to cognitive impairments, emotional distress, and difficulties in resuming work or other daily life activities. Therefore, in this position paper, we call for a change in neurological care and a shift in patient communication, emphasizing the importance of addressing patient needs and fostering realistic expectations rather than solely focusing on the benign nature of the condition.
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Affiliation(s)
- Sara Khosdelazad
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jacoba M Spikman
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Sofie Solvang
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke J H Wermer
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Lieke S Jorna
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sandra E Rakers
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Anne M Buunk
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Jorna LS, Khosdelazad S, Kłos J, Rakers SE, van der Hoorn A, Potze JH, Borra RJH, Groen RJM, Spikman JM, Buunk AM. Automated magnetic resonance imaging quantification of cerebral parenchymal and ventricular volume following subarachnoid hemorrhage: associations with cognition. Brain Imaging Behav 2024; 18:1. [PMID: 38294581 PMCID: PMC10830824 DOI: 10.1007/s11682-024-00855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
This study aims to investigate cerebral parenchymal and ventricular volume changes after subarachnoid hemorrhage (SAH) and their potential association with cognitive impairment. 17 patients with aneurysmal SAH (aSAH) and 21 patients with angiographically negative SAH (anSAH) without visually apparent parenchymal loss on conventional magnetic resonance imaging (MRI) were included, along with 76 healthy controls. Volumetric analyses were performed using an automated clinical segmentation and quantification tool. Measurements were compared to on-board normative reference database (n = 1923) adjusted for age, sex, and intracranial volume. Cognition was assessed with tests for psychomotor speed, attentional control, (working) memory, executive functioning, and social cognition. All measurements took place 5 months after SAH. Lower cerebral parenchymal volumes were most pronounced in the frontal lobe (aSAH: n = 6 [35%], anSAH n = 7 [33%]), while higher volumes were most substantial in the lateral ventricle (aSAH: n = 5 [29%], anSAH n = 9 [43%]). No significant differences in regional brain volumes were observed between both SAH groups. Patients with lower frontal lobe volume exhibited significantly lower scores in psychomotor speed (U = 81, p = 0.02) and attentional control (t = 2.86, p = 0.004). Additionally, higher lateral ventricle volume was associated with poorer memory (t = 3.06, p = 0.002). Regional brain volume changes in patients with SAH without visible parenchymal abnormalities on MRI can still be quantified using a fully automatic clinical-grade tool, exposing changes which may contribute to cognitive impairment. Therefore, it is important to provide neuropsychological assessment for both SAH groups, also including those with clinically mild symptoms.
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Affiliation(s)
- Lieke S Jorna
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sara Khosdelazad
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Justyna Kłos
- Department of Nuclear Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra E Rakers
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Hendrik Potze
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ronald J H Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Jacoba M Spikman
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne M Buunk
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Khosdelazad S, Jorna LS, Rakers SE, Koffijberg R, Groen RJM, Spikman JM, Buunk AM. Long-term Course of Cognitive Functioning After Aneurysmal and Angiographically Negative Subarachnoid Hemorrhage. Neurosurgery 2023; 93:1235-1243. [PMID: 37272715 DOI: 10.1227/neu.0000000000002559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/17/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cognitive impairment is a common consequence of subarachnoid hemorrhage (SAH), negatively affecting everyday functioning. This study is the first to investigate the long-term course of cognitive functioning after SAH and its associations with long-term well-being (ie, anxiety and depression), cognitive complaints, and return to work, separately for patients with aneurysmal SAH (aSAH) and angiographically negative SAH (anSAH) in a longitudinal design. METHODS Cognitive functioning was measured at 2 time points (T1: 3-6 months post-SAH; T2: 2-4 years post-SAH) in 58 patients with aSAH and 22 patients with anSAH with neuropsychological tests for (working) memory, psychomotor speed, and attention/executive functioning. Questionnaires were used to measure cognitive complaints and well-being at T1 and T2 and return to work at T2. RESULTS At T2, patients with aSAH only showed improvements in memory and on an executive functioning and psychomotor speed subtest, whereas in contrast, patients with anSAH had significantly poorer scores on tests for psychomotor speed. A significant amount of patients with aSAH and anSAH still reported cognitive complaints, anxiety, and depression in the chronic stage. Cognitive functioning was not significantly associated with cognitive complaints in both SAH groups. On the other hand, cognitive complaints were related to well-being at the long-term in both SAH groups. More cognitive complaints were also associated with more difficulties in return to work in patients with aSAH. CONCLUSION Patients with aSAH and anSAH have cognitive impairments at the subacute stage post-SAH, and these impairments persist into the chronic stage. Moreover, both SAH groups still reported decreased well-being in the chronic stage post-SAH, related to cognitive complaints but not to cognitive impairment. For clinical practice, an early neuropsychological assessment will already provide relevant information to estimate long-term cognitive impairment, but in addition, it is important to pay attention to psychological distress at the long-term.
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Affiliation(s)
- Sara Khosdelazad
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Lieke S Jorna
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Sandra E Rakers
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Ralf Koffijberg
- Department of Medical Psychology, Medical Center Leeuwarden, Leeuwarden , The Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Jacoba M Spikman
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Anne M Buunk
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
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Khosdelazad S, Jorna LS, Groen RJM, Rakers SE, Timmerman ME, Borra RJH, van der Hoorn A, Spikman JM, Buunk AM. Investigating Recovery After Subarachnoid Hemorrhage With the Imaging, Cognition and Outcome of Neuropsychological Functioning After Subarachnoid Hemorrhage (ICONS) Study: Protocol for a Longitudinal, Prospective Cohort Study. JMIR Res Protoc 2022; 11:e38190. [PMID: 36173673 PMCID: PMC9562051 DOI: 10.2196/38190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/26/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background A subarachnoid hemorrhage is a hemorrhage in the subarachnoid space that is often caused by the rupture of an aneurysm. Patients who survive a subarachnoid hemorrhage have a high risk of complications and a negative long-term outcome. Objective The aim of the Imaging, Cognition and Outcome of Neuropsychological functioning after Subarachnoid hemorrhage (ICONS) study is to investigate whether and to what extent deficits exist in multiple domains after subarachnoid hemorrhage, including cognition, emotion and behavior, and to investigate whether brain damage can be detected in patients with subarachnoid hemorrhage. We aim to determine which early measures of cognition, emotion and behavior, and brain damage in the subacute stage play a role in long-term recovery after subarachnoid hemorrhage. Recovery is defined as functioning at a societal participation level, with a focus on resuming and maintaining work, leisure activities, and social relationships over the long term. Methods The ICONS study is an observational, prospective, single-center cohort study. The study includes patients with subarachnoid hemorrhage admitted to the Neurosurgery Unit of the University Medical Centre Groningen in the Netherlands. The inclusion criteria include diagnosis of an aneurysmal subarachnoid hemorrhage or an angiographically negative subarachnoid hemorrhage, sufficient ability in the Dutch language, and age older than 18 years. Patients will undergo neuropsychological assessment and magnetic resonance imaging 6 months after the subarachnoid hemorrhage. Furthermore, patients will be asked to fill in questionnaires on multiple psychosocial measures and undergo a structured interview at 6 months, 1 year, and 2 years after the subarachnoid hemorrhage. The primary outcome measure of the ICONS study is societal participation 1 year after the subarachnoid hemorrhage, measured with the Dutch version of the Impact on Participation and Autonomy questionnaire. Results The study was launched in December 2019 and recruitment is expected to continue until June 2023. At the time of the acceptance of this paper, 76 patients and 69 healthy controls have been included. The first results are expected in early 2023. Conclusions The ICONS study is the first to collect and combine data after subarachnoid hemorrhage in a variety of domains, including cognition, emotion and behavior, and brain damage. The results will contribute to a more comprehensive understanding of the consequences of both aneurysmal subarachnoid hemorrhage and angiographically negative subarachnoid hemorrhage, which may ultimately optimize timely treatment for this patient group by setting realistic and attainable goals to improve daily functioning. Trial Registration Netherlands Trial Register NL7803; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7803 International Registered Report Identifier (IRRID) DERR1-10.2196/38190
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Affiliation(s)
- Sara Khosdelazad
- Neuropsychology Unit, Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Lieke S Jorna
- Neuropsychology Unit, Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Sandra E Rakers
- Neuropsychology Unit, Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Marieke E Timmerman
- Department of Psychometrics and Statistics, University of Groningen, Groningen, Netherlands
| | - Ronald J H Borra
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Jacoba M Spikman
- Neuropsychology Unit, Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Anne M Buunk
- Neuropsychology Unit, Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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Khosdelazad S, Jorna LS, McDonald S, Rakers SE, Huitema RB, Buunk AM, Spikman JM. Comparing static and dynamic emotion recognition tests: Performance of healthy participants. PLoS One 2020; 15:e0241297. [PMID: 33112932 PMCID: PMC7592751 DOI: 10.1371/journal.pone.0241297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022] Open
Abstract
Facial expressions have a communicatory function and the ability to read them is a prerequisite for understanding feelings and thoughts of other individuals. Impairments in recognition of facial emotional expressions are frequently found in patients with neurological conditions (e.g. stroke, traumatic brain injury, frontotemporal dementia). Hence, a standard neuropsychological assessment should include measurement of emotion recognition. However, there is debate regarding which tests are most suitable. The current study evaluates and compares three different emotion recognition tests. 84 healthy participants were included and assessed with three tests, in varying order: a. Ekman 60 Faces Test (FEEST) b. Emotion Recognition Task (ERT) c. Emotion Evaluation Test (EET). The tests differ in type of stimuli from static photographs (FEEST) to more dynamic stimuli in the form of morphed photographs (ERT) to videos (EET). Comparing performances on the three tests, the lowest total scores (67.3% correct answers) were found for the ERT. Significant, but moderate correlations were found between the total scores of the three tests, but nearly all correlations between the same emotions across different tests were not significant. Furthermore, we found cross-over effects of the FEEST and EET to the ERT; participants attained higher total scores on the ERT when another emotion recognition test had been administered beforehand. Moreover, the ERT proved to be sensitive to the effects of age and education. The present findings indicate that despite some overlap, each emotion recognition test measures a unique part of the construct. The ERT seemed to be the most difficult test: performances were lowest and influenced by differences in age and education and it was the only test that showed a learning effect after practice with other tests. This highlights the importance of appropriate norms.
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Affiliation(s)
- Sara Khosdelazad
- Department of Neuropsychology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- * E-mail:
| | - Lieke S. Jorna
- Department of Neuropsychology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Sandra E. Rakers
- Department of Neuropsychology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rients B. Huitema
- Department of Neuropsychology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anne M. Buunk
- Department of Neuropsychology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jacoba M. Spikman
- Department of Neuropsychology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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