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Social cognition and behavioral problems persist after subarachnoid hemorrhage: a longitudinal cohort study - 05/12/25

Doi : 10.1016/j.rehab.2025.102015 
Lieke S. Jorna a, , Sara Khosdelazad a, Sandra E. Rakers a, Rob J.M. Groen b, c, Ralf Koffijberg d, Joke M. Spikman a, Anne M. Buunk a, b
a Department of Neurology, unit Neuropsychology, University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands 
b Department of Neurosurgery, University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands 
c Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Jl. Prof. Dr. Moestopo No.6-8, Airlangga, Kec. Gubeng, Surabaya, Jawa Timur 60286, Indonesia 
d Department of Medical Psychology, Medical Center Leeuwarden, Henri Dunantweg 2, Leeuwarden 8934 CE, The Netherlands 

Corresponding author.

Highlights

Social cognition impairments persist over time.
Behavioral problems remain stable or worsen over time.
Behavioral problems, not social cognition deficits, impact societal participation.
Social cognition impairments relate to informant-rated apathy.

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Abstract

Background

Aneurysmal subarachnoid hemorrhage (aSAH) and angiographically negative subarachnoid hemorrhage (anSAH) can result in problems in social cognition and behavior, potentially affecting societal participation.

Objectives

To assess the long-term course of social cognition and behavior, and their impact on societal participation in the chronic stage following aSAH and anSAH.

Methods

In this longitudinal, prospective cohort study, neuropsychological assessments were conducted at 3–6 months (T1) and 2–4 years (T2) after SAH. Social cognition was measured using tests for emotion recognition (FEEST) and Theory of Mind (Cartoon Test, Faux Pas Test). Social behavioral problems were assessed using items on social behavior from the Dysexecutive Questionnaire (DEX-Soc), rated by both participants and informants. Apathy was assessed using self- and informant-rated versions of the Apathy Evaluation Scale (AES). Societal participation was evaluated with the Role Resumption List (RRL).

Results

Eighty-one participants with SAH (59 aSAH and 22 anSAH) and 60 age-, sex-, and education-matched healthy individuals were included. At T1, participants with aSAH performed significantly worse than healthy individuals on the FEEST ( P = 0.001) and Cartoon Test ( P < 0.001), with no substantial improvement at T2. Participants with anSAH showed no deficits in social cognition at T1, and their scores remained stable over time. Behavioral problems in participants with aSAH remained stable, while informant-rated social behavioral problems (DEX-Soc-I) in the anSAH group increased over time ( P = 0.003). In the total SAH group, lower FEEST scores correlated with higher AES-I scores at both time points ( r = −0.26), while worse Cartoon Test scores correlated with AES-I at T1 only ( r = −0.25). Behavioral problems at T1, not social cognition, were associated with reduced societal participation at T2 ( r = 0.24–0.31).

Conclusion

Social cognition impairments after aSAH persist over time, while behavioral problems may worsen after anSAH and are related to long-term societal participation.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Behavioral problems, Social cognition, Societal participation, Stroke, Subarachnoid hemorrhage, Theory of mind

Abbreviations : AES, AES-I, AES-S, anSAH, aSAH, DEX, DEX-Soc-I, DEX-Soc-S, FEEST, RRL, SAH, TBI, ToM, UMCG, WFNS


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