Psychological and Cognitive Effects in Unruptured and Ruptured Intracranial Aneurysms

Overview

This study compares psychological and cognitive outcomes in patients with unruptured intracranial aneurysms (UIAs) and those who survived aneurysmal subarachnoid hemorrhage (aSAH). Findings highlight significant anxiety, depression, cognitive impairments, and reduced quality of life in both groups, with more pronounced deficits following aSAH.

Background

Intracranial aneurysms, including UIAs and those causing aSAH, present complex clinical challenges beyond neurological damage, notably psychological distress and cognitive dysfunction. UIAs often cause chronic anxiety due to fear of rupture, impacting quality of life even without bleeding. aSAH survivors frequently experience persistent cognitive deficits in memory, executive function, and emotional regulation, alongside elevated anxiety and depression. Treatment decisions in Hungary follow multidisciplinary assessment and are influenced by aneurysm characteristics and patient factors, with endovascular approaches preferred for ruptured aneurysms.

Data Highlights

The study included two groups: patients with aSAH and patients with UIAs. Inclusion criteria required patients to be adults, with aSAH patients having confirmed hemorrhage and at least six months post-event. Psychological assessments measured anxiety, depression, sleep quality, and cognitive function. The study also compared these groups to healthy controls to evaluate changes in psychological and cognitive status after aneurysm diagnosis.

Key Findings

• Patients with UIAs experience significant anxiety and depression related to fear of aneurysm rupture, negatively affecting quality of life despite absence of hemorrhage.
• aSAH survivors show a wide range of cognitive impairments, including memory, executive function, processing speed, and social cognition deficits.
• Approximately one-third of aSAH patients exhibit emotional regulation difficulties such as apathy and alexithymia, impacting interpersonal behavior.
• Psychological distress in aSAH patients is compounded by trauma from hemorrhage and is associated with sleep disturbances.
• Treatment modality may influence cognitive outcomes, with minimally invasive endovascular techniques potentially preserving cognitive function better than surgical clipping.
• Comprehensive multidisciplinary care addressing neurological, psychological, and cognitive aspects is essential for optimal patient recovery and quality of life.

Clinical Implications

Clinicians should incorporate routine psychological and cognitive assessments in managing patients with UIAs and aSAH to identify and address anxiety, depression, and cognitive deficits early. Treatment planning must consider the impact of intervention type on cognitive outcomes. Multidisciplinary approaches including neuropsychological support can improve overall well-being and guide individualized care strategies.

Conclusion

Both unruptured and ruptured intracranial aneurysms significantly affect psychological health and cognitive function, necessitating holistic management beyond neurological treatment. Addressing these dimensions can enhance patient quality of life and recovery trajectories.

References

1. Comprehensive Evaluation of Psychological and Cognitive Effects in Intracranial Aneurysms