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Published on: December 16, 2022
Association of Cognitive Impairment After Hemorrhagic Stroke With Psychiatric Outcomes and Functional Status
Saami Zakaria1, Hamza Ahmed1, Kara R Melmed1,2
1Department of Neurology, New York University (NYU) Langone Medical Center, New York.
Insights
Cognitive impairment is common after hemorrhagic stroke, with over half of patients experiencing poor cognition three months later. This cognitive decline is significantly linked to increased anxiety and poorer functional status.
Area of Science:
- Neurology
- Psychiatry
- Rehabilitation Medicine
Background:
- Hemorrhagic stroke, including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), can lead to long-term cognitive and psychiatric deficits.
- Assessing the relationships between cognitive function, psychiatric outcomes, and functional status is crucial for patient recovery and management.
Purpose of the Study:
- To determine the relationships among cognitive impairment, psychiatric outcome, and functional status three months after a hemorrhagic stroke.
- To evaluate these relationships specifically in patients with ICH or SAH, and in patients with ICH only.
Main Methods:
- Prospective study of 101 patients (62 ICH, 39 SAH) assessed via telephone three months post-discharge.
- Utilized the Quality of Life in Neurological Disorders (Neuro-QoL) for cognitive function, anxiety, depression, and sleep disturbance.
- Assessed functional status using the modified Rankin Scale (mRS).
Main Results:
- 51% of patients exhibited poor cognition (Neuro-QoL T score ≤50) three months post-hemorrhage.
- Poor cognition was significantly associated with anxiety (OR=4.38 for full cohort, OR=10.98 for ICH), depression, sleep disturbance, and higher mRS scores (3-5).
- Multivariate analysis confirmed poor cognition's association with anxiety and functional impairment (mRS 3-5).
Conclusions:
- Poor cognition is significantly associated with anxiety three months after hemorrhagic stroke.
- These findings highlight the importance of addressing cognitive deficits and psychiatric comorbidities in stroke recovery.
- Further research is warranted to explore anxiety treatment's potential impact on cognitive function in this population.
Objective:
The authors sought to determine the relationships among cognitive impairment, psychiatric outcome, and functional status 3 months after a hemorrhagic stroke.
Methods:
Patients with nontraumatic intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) were assessed by telephone 3 months after discharge by using the Quality of Life in Neurological Disorders (Neuro-QoL) cognitive function, anxiety, depression, and sleep disturbance short forms, as well as the modified Rankin Scale (mRS). The relationships between poor cognition (Neuro-QoL T score≤50), functional status, and psychiatric outcome among patients with ICH or SAH and patients with ICH only were evaluated.
Results:
Of 101 patients (N=62 with ICH and N=39 with SAH), 51% had poor cognition 3 months posthemorrhage, with 61% having mRS scores of 3-5, 43% having anxiety, 28% having depression, and 31% having sleep disturbance. Univariate analysis of the full cohort indicated that poor cognition was significantly associated with anxiety, depression, sleep disturbance, and mRS scores of 3-5 (p<0.05). Multivariate analysis revealed that poor cognition was significantly associated with anxiety (OR=4.38, 95% CI=1.30-14.74, p=0.017) and mRS scores of 3-5 (OR=6.15, 95% CI=1.96-19.32, p=0.002). Univariate analysis of the 62 patients with ICH indicated that poor cognition was significantly associated with anxiety, sleep disturbance, and mRS scores of 3-5 (p<0.05). Multivariate analysis revealed that poor cognition was significantly associated with anxiety (OR=10.98, 95% CI=2.32-51.99, p=0.003).
Conclusions:
Poor cognition was associated with anxiety 3 months after hemorrhagic stroke. Additional research is needed to understand whether treatment for anxiety would improve cognition in this population.
