Domain-specific characterisation of early cognitive impairment following spontaneous intracerebral haemorrhage

Abstract

Cognitive deficits after spontaneous intracerebral haemorrhage (ICH) are common and result in functional impairment, but few studies have examined deficits across cognitive domains in the subacute phase. This study aims to describe the cognitive profile following acute ICH and explore how cerebral amyloid angiopathy (CAA) may impact performance. We retrospectively reviewed 187 consecutive patients with ICH (mean age 58.9 years, 55.6% male) with available imaging and neuropsychological data (median 12 days after stroke). In our cohort, 84% (n = 158) were impaired in at least one cognitive domain and 65% (n = 122) in two or more domains. Deficits in non-verbal IQ (76.6%), information processing speed (62.4%) and executive functions (58.1%) were most common. Patients with lobar ICH (n = 92) had more deficits in naming and visual perception than those with non-lobar ICH, but not in adjusted analyses. Patients with probable CAA (n = 21) had more deficits in verbal IQ, visual perception and executive functions than those without probable CAA; in adjusted analyses, probable CAA predicted impairment in verbal IQ (OR 38.6, 95% CI 3.2 to 465.4, p = 0.004) and executive function (OR 3.4, 95% CI 1.0 to 11.7, p = 0.050). We conclude that cognitive deficits following ICH are common across domains, and that those with CAA appear to have a different cognitive profile. Replication of this work in larger cohorts will be important for confirming and further quantifying these observations.

Cognitive Impairment After Intracerebral Hemorrhage: A Systematic Review of Current Evidence and Knowledge Gaps

“…Three additional studies chose to selectively exclude patients that met the criteria for dementia but included patients with mild impairments, using preexisting dementia as a contributory factor for future deficits (12,23,28). The remaining studies [9 (28.1%)] either did not assess or report on preexisting CI (5,6,15,21,24,27,32,34,36).…”

“…The three acute phase studies reported that 84.0% of ICH patients demonstrated impairment in one or more cognitive domain at 12 days post-stroke (5,16,31), with 65.0% showing impairment in two or more domains (5), 75.2% of patients impaired at 2 weeks (16) and 82.4% of patients showing 2+ domain impairment at 3 weeks (31). Of the 3 studies, 1 assessed for delirium before testing (41) and 2 assessed for disorders of consciousness and aphasia (16,31).…”

“…Of the 3 studies, 1 assessed for delirium before testing (41) and 2 assessed for disorders of consciousness and aphasia (16,31). Lobar and dominant-hemisphere ICH, and increased admission systolic blood pressure (SBP) were noted as factors associated with CI in this period (5,16). Specifically, patients with lobar ICH showed higher rates of impairment in two or more domains (73.0% lobar vs. 58.0% non-lobar) while dominant-hemisphere hemorrhage and higher SBP showed respective odds ratios (OR) of 8.85 and 1.02 for impairment.…”

“…In 13 (40.6%) studies, determination for CI was made based on general diagnosis (23,36), DSM-IV (11,14,22,24,26,29,38), DSM-V (7), ICD-9 (40), and ICD-10 (6, 10, 19) diagnostic criteria. Finally, 5 (15.6%) defined CI by the relative decrease in function from baseline assessments (5,28,30,33,39).…”

“…Cognitive Impairment (CI) commonly coexists with ICH. The majority of ICH patients exhibit acute phase CI, with impairments reported in up to 84% of patients (5). While the immediate post-ICH cognitive effects and the potential for long-term CI (6) are broadly recognized, several evidence gaps persist.…”