Social cognition and behavioral problems persist after subarachnoid hemorrhage: a longitudinal cohort study.

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.