Relation of gray-white matter ratio with long-term cognitive functions and quality of life in patients with mild to moderate aneurysmal subarachnoid hemorrhage: a prospective observational study

• Published in: Acta neurochirurgica Vol. 160; no. 1; pp. 181 - 189
• Main Authors: Ali, Achmet, Tanirgan, Gamze, Sabanci, Pulat Akin, Sivrikoz, Nukhet, Abdullah, Taner, Sencer, Altay, Sencer, Serra, Orhan-Sungur, Mukadder, Akinci, Ibrahim Ozkan
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 2018; Springer Nature B.V
• Subjects: Aneurysm; Aneurysms; Bleeding; Brain; Cognitive ability; Correlation coefficient; Correlation coefficients; Demographic variables; Demographics; Demography; Females; Hemorrhage; Interventional Radiology; Magnetic resonance imaging; Males; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neuroimaging; Neurology; Neuroradiology; Neurosurgery; NMR; Nuclear magnetic resonance; Observational studies; Original Article - Vascular; Quality of life; Risk factors; Subarachnoid hemorrhage; Substantia alba; Substantia grisea; Surgical Orthopedics; Vasoconstriction; Neuroimaging; Cognitive function; Subarachnoid hemorrhage; Intracranial aneurysm; Gray-white matter ratio; Quality of life
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-017-3374-y

Background
In the present study, we hypothesized that a low gray matter-white matter ratio (GWR) is associated with poor cognitive function and low quality of life in patients with mild to moderate (WFNS ≤3) aneurysmal subarachnoid hemorrhage (aSAH).
Methods
All patients with aSAH who were admitted to the neurointensive care unit (Neuro ICU) and whose WFNS score was ≤ 3 were enrolled in the study. During the Neuro ICU follow-up period, the following variables were recorded: demographics, neurological status, comorbidities, time elapsed between onset of bleeding and Neuro ICU admission, treatment method, number of days with vasospasm symptoms (DVS) and vasopressor usage. One year after bleeding, all patients except those who could not answer the questionnaires appropriately were administered the MoCA and SF-36 tests, and brain magnetic resonance imaging and then volumetric brain analysis were performed.
Results
Eighty-two patients completed the study. One year after aSAH, cognitive dysfunction and low quality of life were observed in 59.8% and 25.6% of patients, respectively. Among the variables obtained during Neuro ICU follow-up, DVS was found to be a major risk factor for cognitive dysfunction (OR: 3.9, 95% CI: 1.9–7.8;
p
 < 0.001), poor quality of life (OR: 2.8, 95% CI: 1.4–5.3,
p
 = 0.002) and a lower GWR value (
p
 < 0.001, correlation coefficient = −0.410, R2 = 0.234). One year after aSAH, higher GWR values were associated with higher MoCA (R2 = 0.506 for males, R2 = 0.413 for females) and SF-36 (R2 = 0.270 for males, R2 = 0.364 for females) scores in both genders. Also, GWR ≤ 1.35 in males and GWR ≤1.33 in females indicated MoCApoor patients with over 80% specificity and sensitivity.
Conclusion
GWR has good correlation with the MoCA and SF-36 score, and a low GWR can indicate cognitive dysfunction. In this context, GWR can be used as an additional method to evaluate cognitive function and quality of life.