A new nationwide population-based cohort study from South Korea has found that preventive treatment for unruptured intracranial aneurysms (UIAs) does not increase the risk of developing dementia in the long run. The study compared the incidence of dementia between patients who received preventive treatment and those under observation, as well as between different treatment modalities – surgical and endovascular. The findings suggest that the current preventive strategies for UIAs are safe in terms of long-term cognitive outcomes.
No Increased Dementia Risk from UIA Treatment
Unruptured intracranial aneurysms (UIAs) are balloon-like bulges in the brain’s blood vessels that, if left untreated, can rupture and cause a life-threatening subarachnoid hemorrhage. To prevent this, doctors often recommend preventive treatments such as surgical clipping or endovascular coiling. However, concerns have been raised about the potential long-term cognitive impacts of these procedures.
The new study, published in the journal Scientific Reports, set out to investigate the association between preventive treatment for UIAs and the development of dementia over a 10-year period. Researchers used data from the National Health Insurance Service-Senior Cohort (NHIS-SC) database in South Korea, which includes a representative sample of the elderly population.
Matching Patients to Minimize Confounding
The researchers compared the incidence of dementia between two groups: those who received preventive treatment for UIAs and those who were under observation. They also compared the risk between patients who underwent surgical clipping versus endovascular coiling.
To minimize the effects of potential confounding factors, the researchers used a technique called propensity score matching. This allowed them to create comparable groups of patients with similar underlying characteristics, such as age, sex, and medical history.
No Difference in Dementia Incidence
After matching, the researchers found no significant difference in the 10-year incidence of dementia between the treatment and observation groups. The incidence rates were 9.82 and 8.68 per 1,000 person-years, respectively, with no statistically significant difference in the hazard ratio.
Furthermore, the risk of developing dementia was also similar between the surgical and endovascular treatment groups, with 10-year incidence rates of 8.79 and 8.65 per 1,000 person-years, respectively.
Subgroup Analysis Suggests Potential Risk in Male Patients
However, the researchers did find one notable subgroup difference. Among male patients, those who underwent surgical clipping had a higher risk of developing dementia compared to those who received endovascular treatment (hazard ratio: 2.34).
The researchers suggest that this increased risk in male patients may be due to factors such as progressive brain atrophy with age, particularly in the regions accessed during surgical procedures, as well as a higher susceptibility to traumatic brain injury and its associated dementia risk.
Limitations and Future Research
The study had some limitations, including the use of administrative claims data, which lacked detailed information about the location and size of the aneurysms, as well as the specific surgical techniques and devices used. Additionally, the researchers were unable to capture all treatment-related complications that could impact dementia risk.
Despite these limitations, the study provides valuable insights into the long-term cognitive outcomes of preventive treatment for UIAs. The researchers emphasize the need for further investigations, particularly to identify the high-risk patient populations that may be more vulnerable to developing dementia following UIA treatment.
Author credit: This article is based on research by Hyun Jin Han, Seonji Kim, Jung-Jae Kim, Yong Bae Kim, Seung Il Kim, Seng Chan You, Keun Young Park.
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