Prevalence of cognitive complaints and impairment in patients with Chronic Subdural Hematoma and recovery after treatment: a systematic review.

BACKGROUND Chronic Subdural Hematoma (CSDH) is a frequently occurring neurological disease associated with older age and use of anticoagulants. Symptoms vary from headaches to coma, but also cognitive deficits can be present. However, exact prevalence and severity of cognitive deficits in CSDH are still unknown. OBJECTIVE In this systematic review, we aim to assess cognitive status of patients with CSDH, at presentation and after treatment. METHODS Pubmed, Embase and Psyqinfo, were searched for articles concerning cognition in CSDH. We divided cognition changes into subjective cognitive deficit (Cognitive Complaints: CC) and objective cognitive deficit (Cognitive Impairment: CI). Two reviewers independently selected studies for inclusion and subsequently extracted data. Quality assessment was done by means of the Newcastle-Ottowa Scale. Reported prevalence of CC and CI was pooled with random effects meta-analysis. RESULTS Out of 768 identified references, 20 met inclusion criteria. Estimated prevalence of CC and CI in CSDH at presentation was 45% (95% CI: 36% to 54%). Four studies concerned a prospective evaluation of the effect of surgical treatment on cognition. These proved to be of fair to good quality after quality assessment. The estimated pre-treatment prevalence of objectified cognitive impairment was 61% (95% CI: 51% to 70%) decreasing to 18% (95% CI: 8% to 32%) post-surgery Conclusion: From this review it can be concluded that CC and CI are very common in CSDH with a tendency to improve after treatment. Therefore, we underline the importance of increased attention to cognitive status of these patients, with proper testing methods and treatment-testing intervals.