Depressive symptoms profile and dementia risk after spontaneous intracerebral haemorrhage

Depressive symptoms are commonly reported after spontaneous intracerebral haemorrhage (ICH) and frequently associated with cognitive decline. Using hierarchical clustering analysis (HCA), we aimed to identify different post-ICH depressive symptoms profiles and to evaluate their association with dementia risk.

We included consecutive patients from the prospective Prognosis of Intracerebral Haemorrhage (PITCH) study who survived 6 months after the ICH. We performed HCA using depressive symptoms severity (assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS)), along with the presence of apathy and anxiety (screened using Neuropsychiatric Inventory questionnaire). Baseline clinical/neuroimaging characteristics and risk of incident dementia were compared between different profiles using univariate and multivariable models.

Of 265 six-month ICH survivors, 221 (83%) underwent neuropsychiatric screening (mean age 65.5 years; 57% male). Using HCA, 3 profiles were identified: (1) without significant depressive symptoms (n = 152; median MADRS score = 2 [IQR 0-4]); (2) depressive symptoms with predominant apathy (n = 41; median MADRS score = 15 [IQR 5-20], 68% with apathy); (3) depressive symptoms profile with predominant anxiety (n = 28; median MADRS score = 17 [IQR 9-25]; 100% with anxiety). Compared to patients without depressive symptoms, patients with depressive symptoms and predominant apathy (but not those with predominant anxiety) were more likely to have cerebral atrophy (OR = 2.4, 95% CI = 1.4-4.2) and had significantly higher long-term new-onset dementia risk (adjusted hazard ratio = 2.2, 95% CI = 1.3-3.8).

Screening for apathy and anxiety on top of depressive symptoms might help identifying patients at risk for dementia. Future studies on treatment should account for different post-ICH depressive symptoms profiles that may impact on cognitive function.