Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK; Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK.
Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK.
J Stroke Cerebrovasc Dis. 2022 Jan;31(1):106184. doi: 10.1016/j.jstrokecerebrovasdis.2021.106184. Epub 2021 Nov 10.
Survivors of aneurysmal subarachnoid haemorrhage (aSAH) frequently suffer from cognitive dysfunction. The aim of this study was to assess, in a large sample size with long term follow-up, the characteristics of cognitive dysfunction following aSAH and explore whether cognitive deficits mediate employment outcome.
In this retrospective case-controlled study, aSAH survivors (n = 884) were identified from the UK Biobank and compared to matched controls (n = 3536). Controls were propensity score matched according to age, sex, Townsend deprivation score, educational status and relevant medications known to influence cognition. Cognitive outcomes and employment status were compared between cases and controls using group comparison and cross-tabulation tests. A regression-based mediation analysis was performed to assess whether cognitive deficits mediate employment status following aSAH.
Psychomotor reaction time and employment status significantly differed between aSAH cases and controls with slower reaction times (p < 0.001) and more unemployment or inability to work due to illness (p < 0.001) in the aSAH cohort at a mean follow-up of 125 months. Psychomotor slowing was estimated to mediate a significant proportion (6.59%) of the effect of aSAH on employment status.
Psychomotor reaction time and employment status differed significantly between aSAH cases and control matched individuals in the UK Biobank. Psychomotor slowing following aSAH had a discernible impact on employment status. Psychomotor reaction time and employment status are practical to acquire and can be used as surrogate measures of outcome in future studies of aSAH survivors.
蛛网膜下腔出血（aSAH）幸存者常伴有认知功能障碍。本研究旨在通过大样本长期随访，评估 aSAH 后认知功能障碍的特点，并探讨认知缺陷是否会影响就业结果。
本回顾性病例对照研究从英国生物库中确定了 aSAH 幸存者（n=884），并与匹配的对照者（n=3536）进行了比较。对照者根据年龄、性别、汤森贫困剥夺指数、教育程度和已知影响认知的相关药物进行倾向评分匹配。采用组间比较和交叉表检验比较病例组和对照组的认知结局和就业状况。采用回归中介分析评估认知缺陷是否介导 aSAH 后的就业状况。
aSAH 病例组和对照组之间的精神运动反应时间和就业状况存在显著差异，aSAH 组的反应时间较慢（p<0.001），且由于疾病无法工作或失业的比例更高（p<0.001），平均随访时间为 125 个月。精神运动速度减慢估计在 aSAH 对就业状况的影响中存在显著比例（6.59%）的中介作用。
在英国生物库中，aSAH 病例组和对照组之间的精神运动反应时间和就业状况存在显著差异。aSAH 后精神运动速度减慢对就业状况有明显影响。精神运动反应时间和就业状况易于获取，可作为未来 aSAH 幸存者研究中结局的替代指标。
