Decision-Making Impairment on the Iowa Gambling Task After Endovascular Coiling or Neurosurgical Clipping for Ruptured Anterior Communicating Artery Aneurysm

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Abstract

Objective: To investigate decision-making deficits after anterior communicating artery aneurysm (ACoA) rupture and to compare the effects of two treatments. Method: The sample included 40 patients with subarachnoid hemorrhage secondary to ruptured ACoA with a favorable neurological outcome and a control group of 31 subjects matched by age, sex, and years of education. Twenty patients had surgical interventions (clipping) and 20 had received endovascular treatment. Decision-making was assessed by the Iowa Gambling Task (IGT). We used the Expectancy Valence model to examine the different components associated with the IGT. Results: ACoA patients performed significantly worse on the IGT than controls, we observed poorly performance on IGT in 70% of the patients. Comparing the groups according to type of intervention, we found that clipped patients performed significantly worse than controls on the IGT, whereas coiled patients did not differ significantly from controls or clipped patients; however, coiled patients performed worse than controls on the last block of the task. Patients with frontal lesions selected significantly more cards from the disadvantageous deck. IGT performance correlated with other tests of executive functions such as the perseverative errors and non perseverative errors of Wisconsin Card Sorting Tests, and verbal fluency test, but not with working memory tests. According to the Expectancy Valence model, patients with frontal lesions showed a greater tendency to focus on recent outcomes and ignore or rapidly discount past outcomes, and tended to have a more erratic response pattern. Conclusions: Our results suggest that patients with subarachnoid hemorrhage secondary to ruptured ACoA have deficits in decision-making under ambiguity. The main cause of this deficit is the presence of frontal lesions. Moreover, clipped patients, but not coiled patients, showed deficits in taking decisions in comparison with controls. Our results suggest that the IGT may help to identify neuropsychological sequelae in these patients.

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