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cognitive impairment for clinical trials would generate a single global score, be applicable to both severely injured and highly functional patients, be resistant to demographic bias, have good inter-rater and test-retest reliability, and possess construct validity, so that poor scores are associated with worse neuropsychologic test performance, increased disease severity, and reduced QOL. One study evaluated 3 simple tests of global cognitive status in a cohort of aSAH patients and found that The Telephone Interview of Cognitive Status (21) comes closest to meeting the above criteria (19).

Unlike ischemic cerebral infarction and intracerebral hemorrhage, aSAH oftentimes causes a more subtle form of diffuse brain injury. Although one might guess that the vast majority of patients are affected in a subtle way, in fact, it appears more likely that a subset of 20% to 30% of patients suffers from severe forms of cognitive impairment, with the remainder doing relatively well (19,22). These problems frequently encompass all domains of cognitive functioning, including processing speed, attention and concentration, verbal and visual memory, visual-spatial skills, and executive function (2,3,19,22-26). It has been found that an estimated from 25% to 50% of patients will have significant cognitive impairment at 3 months (3,22). Many studies have identified predictors of cognitive impairment after aSAH. The most consistently identified risk factors include cerebral infarction, global cerebral edema, thick aSAH clot, intraventricular hemorrhage, hydrocephalus, and anterior circulation aneurysmal location (2,3,22-26).

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