This study evaluated participation outcomes one year after aneurysmal subarachnoid hemorrhage (aSAH) compared with matched healthy controls and identified factors associated with participation within the patient group. Forty aSAH survivors and seventy-five controls were assessed 12–14 months post-ictus. Participation was measured with the Utrecht Scale for Evaluation of Rehabilitation–Participation (USER-P), psychological distress with the Hospital Anxiety and Depression Scale (HADS), coping with the Brief COPE, and cognition with the Montreal Cognitive Assessment (MoCA). Compared with controls, patients reported greater participation restrictions (82 vs. 100, p < 0.001), lower frequency (35 vs. 51, p < 0.001), and reduced satisfaction (65 vs. 75, p < 0.001). Anxiety, depression, and avoidant coping independently predicted restrictions (adjusted R² = 0.48), while satisfaction was predicted by employment, fewer depressive symptoms, and less avoidant coping (adjusted R² = 0.52). Lower MoCA scores predicted reduced participation frequency (p = 0.032), and patients with cognitive impairment showed significantly greater restrictions and lower satisfaction. One year after aSAH, survivors experience substantial participation limitations associated with psychological distress, maladaptive coping, and cognitive deficits. These results underscore the importance of cognitive and psychological rehabilitation to enhance long-term participation and social reintegration after aSAH.

Objectives: Survivors of mild-grade aneurysmal subarachnoid hemorrhage (aSAH) often achieve favorable neurological recovery, yet many continue to experience cognitive difficulties and reduced health-related quality of life (HRQoL). The relative contribution of objectively measured cognition and subjective cognitive complaints to long-term HRQoL in this population remains insufficiently clarified. Methods: This prospective cohort study assessed objective and subjective cognitive functioning one year after mild-grade aSAH (Hunt & Hess I–II) and examined their unique contributions to HRQoL. Forty endovascularly treated aSAH survivors and 80 neurologically healthy controls, matched for sex, age, and educational level, were assessed 12–14 months post-ictus using the Montreal Cognitive Assessment (MoCA), Cognitive Failures Questionnaire (CFQ), and SF-36. Results: Compared with controls, patients demonstrated significantly lower MoCA scores, with cognitive impairment present in 42.5% of cases, as well as reduced HRQoL. In multivariate regression analyses adjusted for demographic, clinical, and affective covariates, subjective cognitive complaints (CFQ) remained independently associated with the mental component summary score of the SF-36 (β = −0.47, p = 0.002). Objective cognitive performance (MoCA) was not associated with the SF-36 component summary scores but showed weaker, domain-specific associations in exploratory analyses. The correlation between MoCA and CFQ was weak (ρ = −0.33), indicating a dissociation between these two measures. Conclusions: One year after mild-grade aSAH, subjective cognitive complaints contribute to mental HRQoL above and beyond the influence of affective symptoms. These findings highlight a clinically relevant dissociation between perceived and objectively measured cognition and support the importance of incorporating patient-reported cognitive difficulties into long-term outcome assessment and rehabilitation planning.