Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA.
Neurosurgery. 2009 Dec;65(6):1043-50; discussion 1050-1. doi: 10.1227/01.NEU.0000359317.15269.20.
We sought to determine the frequency, risk factors, and impact on functional outcome and quality of life (QOL) of global cognitive impairment 1 year after subarachnoid hemorrhage.
We prospectively evaluated global cognitive status 3 and 12 months after hospitalization with the Telephone Interview for Cognitive Status in 232 subarachnoid hemorrhage survivors. Cognitive impairment was defined as a score of 30 or less (scaled 0 = worst, 51 = best). Logistic regression was performed to calculate adjusted odds ratios (AORs) for impairment at 1 year. Basic activities of daily living were evaluated with the Barthel Index, instrumental activities of daily living were assessed with the Lawton scale, and QOL was evaluated with the Sickness Impact Profile.
The frequency of cognitive impairment was 27% at 3 months and 21% at 12 months. After the effects of age, education, and race/ethnicity were controlled for, risk factors for cognitive impairment at 12 months included anemia treated with transfusion (AOR, 3.4; P = 0.006), any temperature level higher than 38.6 degrees C (AOR, 2.7; P = 0.016), and delayed cerebral ischemia (AOR, 3.6; P = 0.01). Among cognitively impaired patients at 3 months, improvement at 1 year occurred in 34% and was associated with more than 12 years of education and the absence of fever higher than 38.6 degrees C during hospitalization (P = 0.015). Patients with cognitive impairment at 1 year had worse concurrent QOL and less ability to perform instrumental and basic activities of daily living (all P < 0.001).
Global cognitive impairment affects more than 20% of subarachnoid hemorrhage survivors at 1 year, is predicted by fever, anemia treated with transfusion, and delayed cerebral ischemia, and adversely affects functional recovery and QOL.
我们旨在确定蛛网膜下腔出血后 1 年时发生全球认知障碍的频率、危险因素以及对功能结局和生活质量（QOL）的影响。
我们前瞻性地评估了 232 例蛛网膜下腔出血幸存者在住院后 3 个月和 12 个月的全球认知状态，使用电话访谈认知状态进行评估。认知障碍定义为得分 30 或更低（评分范围为 0=最差，51=最佳）。采用 logistic 回归计算 1 年后受损的调整优势比（AOR）。使用巴氏指数评估基本日常生活活动能力，使用洛顿量表评估工具性日常生活活动能力，使用疾病影响量表评估生活质量。
认知障碍的发生率为 3 个月时为 27%，12 个月时为 21%。在控制年龄、教育程度和种族/民族的影响后，12 个月时认知障碍的危险因素包括输血治疗的贫血（AOR，3.4；P=0.006）、任何高于 38.6°C 的体温水平（AOR，2.7；P=0.016）和迟发性脑缺血（AOR，3.6；P=0.01）。在 3 个月时认知受损的患者中，1 年后改善的有 34%，与超过 12 年的教育程度和住院期间无高于 38.6°C 的发热有关（P=0.015）。1 年时认知障碍的患者并发 QOL 更差，进行工具性和基本日常生活活动的能力更差（均 P<0.001）。
全球认知障碍在 1 年后影响超过 20%的蛛网膜下腔出血幸存者，由发热、输血治疗的贫血和迟发性脑缺血预测，对功能恢复和 QOL 产生不利影响。
