We aim at analyzing the factors associated with neuropsychological function in a large cohort of aneurysmal subarachnoid hemorrhage (aSAH) survivors.

Patients with aSAH admitted to our institution since 2009 were recruited. Montreal cognitive assessment (MoCA) was conducted, and data was adjusted for sex, age, race and years of education. The Beck Depression Inventory 2^nd edition (BDI-II), the Stroke Specific Quality of Live questionnaire (SS-QoL) were completed by patients and their families filled in the Iowa Scale of Personality Changes (ISPC). Multivariate analysis was performed to identify the predictors of cognitive and behavioral outcomes.

A total of 44 out of 113 aSAH survivors (39%) had a MoCA score < 25th percentile. A modified Fisher score of three or four was more common in individuals with a MoCA score < 25th percentile (75% vs. 61%, p = 0.01). However, multivariate analysis determined that new ischemia during hospitalization was the single factor independently associated with MoCA scores. Radiological vasospasm and DCI were significant predictor of worse work productivity (β: -0.35, p=0.019 and β: -0.37, p=0.015) and social relationships (β: -0.40, p=0.008 and β: -0.33, p=0.029). Aneurysm location in the anterior circulation was significantly associated with mild depression, being present in 92% of depressed patients compared to 53% of non-depressed patients (p = 0.018). The most frequently reported personality changes were alterations in executive function personality (50%, n=17). These patients had a higher proportion of modified Fisher scores of 3 and 4 compared to those without personality alterations. (78% vs 31%, p=0.006).

Larger hemorrhage volume and the development of new ischemia during hospitalization are factors associated with cognitive and behavioral outcomes after aSAH. Depression is more frequently observed in patients with aneurysms located in the anterior circulation.