Multiple studies using diverse designs have consistently demonstrated that intellectual impairment is very prevalent after aSAH. Although cognitive function tends to improve over the first year,64 global cognitive impairment is still present in 20% of aSAH patients and is associated with poorer functional recovery and lower quality of life.65 Cog- nitive deficits and functional decline are often compounded by mood disorders (anxiety, depression), fatigue, and sleep disturbances.66 Therefore, scales assessing well-being and quality of life can be particularly useful in the integral assessment of patients with aSAH, even among those who regain functional independence.67,68 Behavioral and psycho- social difficulties, as well as poor physical and mental endurance, are some of the most commonly encountered factors accounting for the inability of otherwise independent patients to return to their previous occupations.66,68 Much remains to be learned about the causes of cognitive and functional deficits after aSAH and the best methods to assess intellectual outcome and functional recovery in these patients. The severity of clinical presentation is the strongest prognostic indicator in aSAH. Initial clinical severity can be Table 4. Continued New or Revised Recommendation Class of Recommendation/ Level of Evidence Revised 3. For patients with ruptured aneurysms judged to be technically amenable to both endovascular coiling and neurosurgical clipping, endovascular coiling should be considered. Class I, Level B Revised 4. Low-volume hospitals (eg, 10 aSAH cases per year) should consider early transfer of patients with aSAH to high-volume centers (eg, 35 aSAH cases per year) with experienced cerebrovascular surgeons, endovascular specialists, and multidisciplinary neuro-intensive care services. Class I, Level B Revised 5. Maintenance of euvolemia and normal circulating blood volume is recommended to prevent DCI. Class I, Level B Revised 6. Induction of hypertension is recommended for patients with DCI unless blood pressure is elevated at baseline or cardiac status precludes it. 