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Predicting return to work after subarachnoid hemorrhage using the Montreal Cognitive Assessment (MoCA)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
2016 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 158, no 2, 233-239 p.Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Returning to work is a major issue for patients having had an aneurysmal subarachnoid hemorrhage (SAH). It is important, at an early stage, to identify the patients that are unlikely to return to work. The objective of this study was to assess the predictive value of the Montreal Cognitive Assessment (MoCA) at 6 months after ictus on return to work at 12 months. In this prospective study were 96 patients with SAH included in the acute phase. Cognitive functions were assessed at 6 months using the MoCA and return to work at 12 months. The predictive value of MoCA on return to work was analyzed using the area under the receiver operating characteristic curve as well as logistic regression. Of those that had work before the SAH, 52 % were working at 12 months after the ictus. These patients had scored significantly better on MoCA at 6 months (p = 0.01). The area under the receiver operating characteristic curve was 0.75. By using a cut-off on MoCA of < 27, 68 % of the patients could be correctly classified as returned/not returned to work. Adding data from the acute phase to the MoCA in a logistic regression model increased the percentage of patients correctly classified as returned/not returned to work by 2 %. Returning to work is a major issue for SAH patients. It is important to identify factors that may interfere with a patient's ability to return to work, and address these issues appropriately. In our study, estimating cognitive functions at 6 months after SAH using the MoCA alone allowed us to predict return to work correctly in 68 % of the cases. We feel that this provides useful information in planning rehabilitation, but that other post-SAH symptoms have to be considered as well.

Place, publisher, year, edition, pages
2016. Vol. 158, no 2, 233-239 p.
Keyword [en]
Subarachnoid hemorrhage, Aneurysmal, Cognitive symptoms, Cognitive impairment, Work capacity, Return to work
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-277979DOI: 10.1007/s00701-015-2665-4ISI: 000368603400004PubMedID: 26676517OAI: oai:DiVA.org:uu-277979DiVA: diva2:908263
Available from: 2016-03-02 Created: 2016-02-23 Last updated: 2017-11-30Bibliographically approved
In thesis
1. Life after Subarachnoid Hemorrhage
Open this publication in new window or tab >>Life after Subarachnoid Hemorrhage
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease with mean age of 59 years. SAH accounts for 5% of all stroke and more than one quarter of potential life years lost through stroke. With the advanced neurosurgical methods of today two thirds of the patients survive. We know, however, that various cognitive, psychiatric and physical impairments are common that affect quality of life, social life, and the ability to work in the aftermath of SAH. The overall aim constituting this PhD dissertation is to better understand some of the challenges often faced by those surviving SAH.

Two SAH patient cohorts have been studied. The first followed 96 consecutively included patients during the first year after ictus. Spasticity and cognitive impairment was assessed after 6 months and the Swedish stroke register follow-up form was used to investigate family support and the use of medical and social services. Return to work was assessed at 12 months. The second cohort assessed attention deficits using the test of variables of attention (T.O.V.A.) at 7 months after ictus in 19 patients with moderate to good recovery.

Spasticity was just as common in our SAH patients as after other stroke, though it was rarely treated pharmacologically. By assessing cognitive impairment at 6 months after ictus using the Montreal cognitive assessment, 68% of the patients could be correctly predicted as having returned/not returned to work at 12 months. Seventeen percent of the patients had not had a follow-up appointment 6 months after ictus. These patients were older, more often living alone, had a lower quality of life, more depressive symptoms and more cognitive impairment compared to those having had a follow-up appointment. Twenty percent had had a follow-up in primary care. Seventy-eight percent of those with moderate to severe disability were living in their own accommodations. Fifty-eight percent of the patients had attention deficits. Challenges after SAH were common and often dealt with in the home environment of the patients.

The results of this thesis highlight the importance of assisting the patients and their relatives in their struggle back to life after SAH.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 97 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1281
Keyword
Aneurysmal, Attention deficit, Cognitive impairment, Family medicine, Follow-up appointments, General practice, Intracranial aneurysm, Outcome, Primary care, Primary health care, Return to work, Spasticity, Stroke, Subarachnoid hemorrhage, Sweden
National Category
Neurology
Research subject
Neurosurgery
Identifiers
urn:nbn:se:uu:diva-307949 (URN)978-91-554-9762-0 (ISBN)
Public defence
2017-01-13, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2016-12-20 Created: 2016-11-23 Last updated: 2016-12-20

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Wallmark, SvanteRonne-Engström, Elisabeth

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