Generic placeholder image

Current Neurovascular Research


ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Research Article

A Direct Correlation between Red Blood Cell Indices and Cognitive Impairment After Aneurysmal Subarachnoid Hemorrhage (aSAH)

Author(s): Li Gong, Yongzhe Gu, Qiong Dong, Xiang Zhang, Haichao Wang, Yanxin Zhao* and Xueyuan Liu*

Volume 16, Issue 2, 2019

Page: [142 - 147] Pages: 6

DOI: 10.2174/1567202616666190412142718

Price: $65


Background: Cognitive impairment can occur after aneurysmal subarachnoid hemorrhage (aSAH) though it commonly tends to be neglected. Red blood cell (RBC) indices are associated with long-term functional outcomes, while it is unclear whether RBC indices could be a potential predictor of cognitive decline after aSAH. We aimed to investigate the association between RBC indices and post-aSAH cognitive impairment at 1 year.

Methods: Patients with aSAH received neuropsychological test by the Montreal Cognitive Assessment (MoCA) and underwent serum and cerebrospinal fluid (CSF) samples test. To determine the association between RBC indices and cognitive impairment after acute aSAH, we adjusted for demographic and vascular risk factors using multivariate logistic regression analysis.

Results: Of the 126 patients included in this study, 33% (42/126) of them were diagnosed with cognitive impairment (MoCA<26). After adjustment for potential confounders, increased mean corpuscular volume (MCV) (OR: 1.36, 95%CI: 1.19-1.55) and mean corpuscular hemoglobin (MCH) (OR: 1.61, 95%CI: 1.25-2.08), reflecting systemic iron status, are more likely to be associated with cognitive impairment after aSAH.

Conclusion: In this aSAH population, our data shows the positive association between MCH and MCV and cognitive impairment at 1 year.

Keywords: Aneurysmal subarachnoid hemorrhage (aSAH), red blood cell (RBC), cerebrospinal fluid (CSF), mean corpuscular hemoglobin (MCH), red cell distribution width (RDW), confidence interval (CI).

Rinkel GJ, Algra A. Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol 2011; 10: 349-56.
Liu JH, Li XK, Chen ZB, et al. D-dimer may predict poor outcomes in patients with aneurysmal subarachnoid hemorrhage: a retrospective study. Neural Regen Res 2017; 12: 2014-20.
Hackett ML, Anderson CS. Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS) group. Health outcomes 1 year after subarachnoid hemorrhage. An international population-based study. Neurology 2000; 55: 658-62.
Ruigrok YM, Buskens E, Rinkel GJE. Attributable risk of common and rare determinants of subarachnoid hemorrhage. Stroke 2001; 32: 1173-5.
Feigin VL, Rinkel GJE, Lawes CMM, et al. Risk factors for subarachnoid hemorrhage: An updated systematic review of epidemiological studies. Stroke 2005; 36: 2773-80.
Wermer MJH, Greebe P, Algra A, Rinkel GJE. Long-term mortality and vascular event risk after aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2009; 80: 1399-401.
Alexander HD, Sherlock JP, Bharucha C. Red cell indices as predictors of iron depletion in blood donors. Clin Lab Haematol 2000; 22: 253-8.
Engström G, Smith JG, Persson M, Nilsson PM, Melander O, Hedblad B. Red cell distribution width, haemoglobin A1c and incidence of Diabetes Mellitus. J Intern Med 2014; 276: 174-83.
Patel KV, Ferrucci L, Ershler WB, Longo DL, Guralnik JM. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009; 169: 515-23.
Malandrino N, Wu WC, Taveira TH, Whitlatch HB, Smith RJ. Association between red blood cell distribution width and macrovascular and microvascular complications in diabetes. Diabetologia 2012; 55: 226-35.
Chugh C, Nyirjesy SC, Nawalinski KP, et al. Red blood cell distribution width is associated with poor clinical outcome after subarachnoid hemorrhage: A pilot study. Neurocrit Care 2015; 23: barachnoid hemorrhage: A pilot study. Neurocrit Care 2015; 23 217-24.
Lu Q, Black SM. Iron metabolism, oxidative stress, and neonatal brain injury. Neural Regen Res 2016; 11: 725-6.
Wong GK, Lam S, Ngai K, Wong A, Mok V, Poon WS. Cognitive dysfunction after aneurysmal subarachnoid haemorrhage investigators. Evaluation of cognitive impairment by the Montreal cognitive assessment in patients with aneurysmal subarachnoid haemorrhage: Prevalence, risk factors and correlations with 3 month outcomes. J Neurol Neurosurg Psychiatry 2012; 83: 1112-7.
Al-Khindi T, Macdonald RL, Schweizer TA. Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. Stroke 2010; 41: 519-36.
Wong GK, Wong R, Mok VC, et al. Clinical study on cognitive dysfunction after spontaneous subarachnoid haemorrhage: Patient profiles and relationship to cholinergic dysfunction. Acta Neurochir 2009; 151: 1601-7.
Wong GK, Wong A, Mok V, Wong A, Poon WS. Natural history and medical treatment of cognitive dysfunction after spontaneous subarachnoid haemorrhage: Review of current literature with respect to aneurysm treatment. J Neurol Sci 2010; 299: 5-8.
Wong GK, Lam SW, Ngai K, et al. Cognitive dysfunction after aneurysmal subarachnoid hemorrhage investigators. Cognitive domain deficits in patients with aneurysmal subarachnoid haemorrhage at 1 year. J Neurol Neurosurg Psychiatry 2013; 84: 1054-8.
Vergouwen MD, Vermeulen M, van Gijn J, et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies. Proposal of a multidisciplinary research group. Stroke 2010; 41: 2391-5.
Shah RC, Schneider JA, Leurgans S, Bennett DA. Association of lower hemoglobin level and neuropathology in community-dwelling older persons. J Alzheimers Dis 2012; 32: 579-86.
Zakai NA, Katz R, Hirsch C, et al. A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: the Cardiovascular Health Study. Arch Intern Med 2005; 165: 2214-20.
Okada T, Suzuki H. Toll-like receptor 4 as a possible therapeutic target for delayed brain injuries after aneurysmal subarachnoid hemorrhage. Neural Regen Res 2017; 12: 193-6.
Duce JA, Tsatsanis A, Cater MA, et al. Iron-export ferroxidase activity of β-amyloid precursor protein is inhibited by zinc in Alzheimer’s disease. Cell 2010; 142: 857-67.
Pichler I, Del Greco MF, Gögele M, et al. Serum iron levels and the risk of Parkinson disease: A Mendelian randomization study. PLoS Med 2013; 10e1001462
Remacha AF, Cadafalch J, Sarda P, Barcelo M, Fuster M. Vitamin B-12 metabolism in HIV-infected patients in the age of highly active antiretroviral therapy: Role of homocysteine in assessing vitamin B-12 status. Am J Clin Nutr 2003; 77: 420-4.
Gong L, Liu XY, Fang M. Recent progress on small vessel disease with cognitive impairment. Int J Clin Exp Med 2015; 8: 7701-9.

Rights & Permissions Print Export Cite as
© 2023 Bentham Science Publishers | Privacy Policy