Psychosocial and neurocognitive performance after spontaneous nonaneurysmal subarachnoid hemorrhage related to the APOE-ε4 genotype: a prospective 5-year follow-up study

Clinical article

Alex Alfieri Department of Neurosurgery, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany;
Departments of Neurosurgery and

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 M.D.
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Vera Unterhuber Psychology, Central General Hospital, Bozen;

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 Psy.D.
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Martina Pircher Psychology, Central General Hospital, Bozen;

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 Psy.D.
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Andreas Schwarz Departments of Neurosurgery and

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Roberto Gazzeri Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy and

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Michael Reinert Department of Neurosurgery, Bern Inselspital Hospital, University of Bern, Switzerland

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 M.D.
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Hans R. Widmer Department of Neurosurgery, Bern Inselspital Hospital, University of Bern, Switzerland

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Object

In this study, the authors prospectively evaluated long-term psychosocial and neurocognitive performance in patients suffering from nonaneurysmal, nontraumatic subarachnoid hemorrhage (SAH) and investigated the association between the APOE-ε4 genotype and outcome in these patients.

Methods

All patients admitted to the authors' institution between January 2001 and January 2003 with spontaneous nonaneurysmal SAH were prospectively examined (mean follow-up 59.8 months). The APOE genotype was determined in all patients by polymerase chain reaction from a blood sample. Of the 30 patients included in this study, 11 were carriers of the ε4 allele.

Results

All patients showed a good recovery and regained full independence with no persisting neurological deficits. The patients with the ε4 allele, however, scored significantly higher on the Beck Depression Inventory (22.1 ± 6.3 vs 14.1 ± 5.1). At follow-up, depression was more persistent in the group with the ε4 allele compared with the group that lacked the allele. This finding reached statistical significance (p < 0.05). Selective attention was impaired in all patients during the first year of follow-up, with an earlier recovery noted in the patients without the ε4 allele. Moreover, there was a tendency toward a linear relationship between the Beck Depression Inventory and the d2 Test of Attention. Two patients who carried the ε4 allele did not return to their employment even after 5 years.

Conclusions

The findings in this study suggest that the APOE genotypes may be associated with the psychosocial and neurocognitive performance after spontaneous nonaneurysmal SAH, even in the absence of neurological impairment. Physicians should consider patient genotype in assessing the long-term consequences of nonaneurysmal SAH.

Abbreviations used in this paper:

BDI = Beck Depression Inventory; GOS = Glasgow Outcome Score; mRS = modified Rankin Scale; NIHSS = National Institutes of Health Stroke Scale; SAH = subarachnoid hemorrhage; TCD = transcranial Doppler.
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