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Published on: April 23, 2021
Prognostic Factors for Cognitive Decline After Intracerebral Hemorrhage
Marije R Benedictus1, Anaïs Hochart2, Costanza Rossi2
1From the Alzheimer Center and Department of Neurology (M.R.B., W.M.v.d.F.) and Department of Epidemiology and Biostatistics (W.M.v.d.F.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; and Department of Neurology, INSERM U 1171, CHRU, University of Lille, Lille, France (A.H., C.R., G.B., H.H., C.C.). charlotte.cordonnier@chru-lille.fr.
Insights
Cognitive decline after intracerebral hemorrhage (ICH) is linked to factors present before the event, like prior strokes and brain atrophy. This suggests ongoing cognitive impairment rather than new decline caused by the hemorrhage itself.
Area of Science:
- Neurology
- Neuroscience
- Public Health
Background:
- Stroke and dementia share complex links.
- Intracerebral hemorrhage (ICH) survivors face risks of cognitive decline.
- No prior prospective studies focused on post-ICH cognitive decline specifically in intracerebral hemorrhage patients.
Purpose of the Study:
- To identify prognostic factors for cognitive decline in intracerebral hemorrhage survivors.
- To investigate predictors of long-term cognitive impairment after ICH.
Main Methods:
- Prospective cohort study of 167 intracerebral hemorrhage survivors without pre-existing dementia.
- Median follow-up of 4 years, assessing cognitive decline via repeated mini-mental state examinations.
- Linear mixed models used to explore prognostic factors, with univariate and multivariable analyses.
Main Results:
- 37% of patients experienced cognitive decline over 4 years.
- Independent predictors identified: prior stroke/TIA, pre-existing cognitive impairment, and cortical atrophy.
- In patients without prior impairment, cortical atrophy was the sole predictor.
Conclusions:
- Prognostic factors for cognitive decline post-ICH are often pre-existing.
- Findings suggest intracerebral hemorrhage may accelerate ongoing cognitive impairment rather than initiating new decline.
Background And Purpose:
Stroke and dementia are closely related, but no prospective study ever focused on poststroke cognitive decline in patients with intracerebral hemorrhage (ICH). We aimed to determine prognostic factors for cognitive decline in patients with ICH.
Methods:
We prospectively included 167 consecutive ICH survivors without preexisting dementia from the Prognosis of Intra-Cerebral Hemorrhage (PITCH) cohort. Median follow-up was 4 years (interquartile range, 2.3-5.4). We explored factors associated with cognitive decline using linear mixed models. Cognitive decline was determined based on repeated mini-mental state examination. We investigated each prognostic factor separately in univariate models. Next, we constructed clinical and radiological multivariable models. In a sensitivity analysis, we excluded patients with preexisting cognitive impairment.
Results:
Median age was 64 (interquartile range, 53-75) years, 69 (41%) patients were women, and median mini-mental state examination at 6 months was 27 (interquartile range, 23-29). Overall, 37% of the patients declined during follow-up. Factors associated with cognitive decline in univariate analyses were previous stroke or transient ischemic attack, preexisting cognitive impairment, microbleed presence, severity of white matter hyperintensities, and severity of cortical atrophy. In multivariable analyses, previous stroke or transient ischemic attack (β [SE], -0.55 [0.23]; P<0.05), preexisting cognitive impairment (β [SE], -0.56 [0.25]; P<0.01), and severity of cortical atrophy (β [SE], -0.50 [0.19]; P<0.01) remained independent prognostic factors. In patients without preexisting cognitive impairment (n=139), severity of cortical atrophy (β [SE], -0.38 [0.17]; P<0.05) was the only prognostic factor for future cognitive decline.
Conclusions:
Prognostic factors for cognitive decline after ICH are already present when ICH occurs, suggesting a process of ongoing cognitive impairment instead of new-onset decline induced by the ICH itself.
