Measuring the Impact of Delayed Cerebral Ischemia on Neuropsychological Outcome After Aneurysmal Subarachnoid Hemorrhage—Protocol of a Swiss Nationwide Observational Study (MoCA–DCI Study)
Authors: Stienen Martin N , Fung Christian , Bijlenga Philippe , Zumofen Daniel W , Maduri Rodolfo , Robert Thomas , Seule Martin A , Marbacher Serge , Geisseler Olivia , Brugger Peter , Gutbrod Klemens , Chicherio Christian , Monsch Andreas U , Beaud Valérie , Rossi Stefania , Früh Severin , Schmid Nicole , Smoll Nicolas R , Keller Emanuela , Regli Luca ,   MoCA-DCI study group, Bozinov Oliver , Burkhardt Jan-Karl , Esposito Giuseppe , Germans Menno R , Keller Emanuela , Krayenbühl Niklaus , Maldaner Nicolai , Neidert Marian C , Regli Luca , Sebök Martina , Serra Carlo , Stienen Martin N , Velz Julia , Marbacher Serge , Fandino Javier , D’Alonzo Donato , Galiagousis Christine , Perren Carline , Stoller Andrea , Nedeltchev Krassen , Guzman Raphael , Mariani Luigi , Zumofen Daniel W , Schulz Marianne , Neddersen Heike , Blackham Kristine , Beck Jürgen , Fung Christian , Goldberg Johannes , Raabe Andreas , Schöni Daniel , Bartoli Andrea , Baticam Nalla Silva , Bijlenga Philippe , Constanthin Paul , Corniola Marco , Goga Cristina , Guatta Ramona , Jannelli Gianpaolo , May Adrien , Moiraghi Alessandro , Molliqaj Granit , Schaller Karl , Sprenger Lima , Wälchli Thomas , Daniel Roy Thomas , Maduri Rodolfo , Rocca Alda , Chiappini Alessio , Reinert Michael , Robert Thomas , Hlavica Martin , Killeen Timothy , Seule Martin A , Weyerbrock Astrid , Schmid Nicole , Kälin Andrea , Monsch Andreas U , Waldmeier Anja Larissa , Albert Djana , Baas Ulrike , Cazzoli Dario , Chavas Silvia , Gutbrod Barbara , Gutbrod Klemens , Heinemann Dörthe , Hofer Helene , Chicherio Christian , Beaud Valérie , Fiorillo Léa , Wahl Laurance , Rossi Stefania , Zanchi Fabiana , Früh Severin , Zimmerer Sylvia , Schwind Marc , Brugger Peter , Dannecker Noemi , Geisseler Olivia , Rothacher Yannick , Schlosser Ladina , Smoll Nicolas R , Zweifel-Zehnder Antoinette E , Schatlo Bawarjan 
Published: March 2018

Abstract

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.