Measuring the Impact of Delayed Cerebral Ischemia on Neuropsychological Outcome After Aneurysmal Subarachnoid Hemorrhage-Protocol of a Swiss Nationwide Observational Study (MoCA-DCI Study)

Neurosurgery. 2019 May 1;84(5):1124-1132. doi: 10.1093/neuros/nyy155.


Background: The exact relationship between delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) and neuropsychological impairment remains unknown, as previous studies lacked a baseline examination after aneurysm occlusion but before the DCI-period. Neuropsychological evaluation of acutely ill patients is often applied in a busy intensive care unit (ICU), where distraction represents a bias to the obtained results.

Objective: To evaluate the relationship between DCI and neuropsychological outcome after aSAH by comparing the Montreal Cognitive Assessment (MoCA) results in aSAH patients with and without DCI at 3 mo with a baseline examination before the DCI-period (part 1). To determine the reliability of the MoCA, when applied in an ICU setting (part 2).

Methods: Prospective, multicenter, and observational study performed at all Swiss neurovascular centers. For part 1, n = 240 consecutive aSAH patients and for part 2, n = 50 patients with acute brain injury are recruited.

Expected outcomes: Part 1: Effect size of the relationship between DCI and neuropsychological outcome (MoCA). Part 2: Reliability measures for the MoCA.

Discussion: The institutional review boards approved this study on July 4, 2017 under case number BASEC 2017-00103. After completion, the results will be offered to an international scientific journal for peer-reviewed publication. This study determines the exact impact of DCI on the neuropsychological outcome after aSAH, unbiased by confounding factors such as early brain injury or patient-specific characteristics. The study provides unique insights in the neuropsychological state of patients in the early period after aSAH.

Keywords: Cognitive disorders; Delayed cerebral ischemia; Montreal Cognitive Assessment; Outcome; Reliability; Stroke; Subarachnoid hemorrhage.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Brain Ischemia / complications*
  • Cognitive Dysfunction / epidemiology*
  • Cognitive Dysfunction / etiology*
  • Female
  • Humans
  • Male
  • Mental Status and Dementia Tests*
  • Middle Aged
  • Prospective Studies
  • Reproducibility of Results
  • Research Design
  • Subarachnoid Hemorrhage / complications*
  • Switzerland