Early Cognitive Impairment at Acute Stage After Intracerebral Hemorrhage

Cognitive impairment after acute intracerebral hemorrhage (ICH) is common. While the evidence of early cognitive impairment at the acute stage after ICH is limited. We determined the frequency and risk factors of early cognitive impairment at the acute stage and investigated its association with delayed cognitive impairment after ICH.

A total of 208 patients with acute ICH were enrolled from January 2017 to February 2019. Cognitive function was assessed during the acute stage and at follow-up using Montreal Cognitive Assessment (MoCA) score. Significant cognitive impairment was defined as having a MoCA score <20 at the acute stage (within 1 week after hospital admission) or during follow-up.

The mean observation period was 20 (IQC 17-23) months, and follow-up cognitive function data were collected from 185 patients. 89 (42.8%) and 86 (46.5%) patients had an acute stage and delayed significant cognitive impairment, respectively. Older age, large baseline hematoma volume, more severe ICH, and low level of education were significantly associated with significant cognitive impairment at the acute stage (all P ≤ 0.009). In the multivariable logistic regression model, the low MoCA score (odds ratio [OR] 0.59; 95% confidence interval [CI] 0.48-0.71; P<0.001) at the acute stage was independently associated with delayed significant cognitive impairment after ICH.

Near half of the patients had significant cognitive impairment at the acute stage after ICH. Cognitive impairment is more frequent in the elderly, those with large baseline hematoma volume, and more severe initial neurological deficit. Having a lower MoCA score during the acute phase was independently associated with an increased risk of delayed cognitive impairment.