Cognitive Deficits and Recovery in Elderly Patients with Chronic Subdural Hematoma

Introduction / Purpose Chronic subdural hematomas (cSDH) represent the most common form of intracranial hemorrhage in the elderly, with an estimated incidence ranging from 2 to 21 cases per 100,000 individuals. Although the incidence has increased over the past decade, the specific effects of cSDH on various domains of cognitive function remain inadequately characterized. In light of these gaps in the literature, the present study was aimed to assess cognitive performance of patients with cSDH at two distinct time points during treatment to better delineate the trajectory of cognitive outcomes in this population. Materials / Methods Patients with a diagnosis of cSDH treated at our institution were enrolled and prospectively followed during the study period from August 2024 until August of 2025. We successfully administered the Montreal Cognitive Assessment (MoCA) and the Controlled Oral Word Association (COWA) in 27 patients prior to the initiation of standard of care procedures. Of these patients, 5 underwent the examination at two time points: before undergoing a standard of care intervention (craniotomy, MMA embolization, medication management) and at 3 ‐ 6 months (+/ ‐ 3 weeks) following the date of treatment. In addition, 7 more patients were enrolled, and one assessment was performed with a second one expected to be completed at the time of conference presentation. Additional information such as thickness of the hematoma, information regarding baseline level of cognitive functioning, and radiographic appearance of the hematoma were also collected. Results One assessment was successfully completed in 27 patients. 5 patients completed the assessments at both time points. In addition, 7 more patients were enrolled, with a second assessment expected to be completed at the time of conference presentation. Scores on the MoCA assessment prior to the initiation of standard of care procedures ranged from 5/30 to 28/30, with the average score being an 8/30. Of those who have completed a follow up assessment, the average score on the MoCA increased by 7.5 points, respectively. Interestingly, the same trend was not observed for scores on the COWA at both time points. The average length of time between each assessment was 3.5 months (+/‐ 3 weeks). GCS scores increased in those with clinical improvement. No interruptions to standard of care workflows were noted. Correlations between changes in assessment scores and appearance of the hematoma at 3‐6 months are being finalized and prepared for the SVIN conference. Conclusions Preliminary analyses have demonstrated that diminished size and resolution of the hematoma is associated with higher scores on the MoCA and the COWA in some patients, mirroring findings in the literature. However, in some patients, MoCA scores decreased despite decreased hematoma volume, which demonstrates the complexity of measuring cognitive function in this population. No standard of care workflow interruptions were noted.