Impact of early cognitive impairment on outcome trajectory in patients with intracerebral hemorrhage

Abstract

ObjectiveTo assess the prevalence and factors associated with early cognitive impairment in intracerebral hemorrhage (ICH) patients and to describe short‐term recovery trajectories among ICH patients with early cognitive impairment.MethodsWe prospectively enrolled ICH patients without baseline dementia in our institutions. Cognitive function was assessed using mini‐mental state examination (MMSE), and functional outcome was evaluated at discharge, 3, and 6 months after symptoms onset using the modified Rankin Scale (mRS). We used multinomial logistic regression models to investigate potential risk factors and generalized linear models to analyze the functional outcome data.ResultsOut of 181 patients with ICH, 167 were included in the final analysis. Early cognitive impairment occurred in 60.48% of patients with ICH. Age (odds ratio [OR] per 1‐year increase, 1.037; 95% confidence interval [CI], 1.003–1.071; p = 0.034), National Institutes of Health Stroke Scale (NIHSS) score (OR per 1‐point increase, 1.146; 95% CI, 1.065–1.233; p < 0.001) and lobar ICH location (OR, 4.774; 95% CI, 1.810–12.593; p = 0.002) were associated with early cognitive impairment in ICH patients. Patients with ≥10 years of education were less likely to experience early cognitive impairment (OR, 0.323; 95% CI, 0.133–0.783; p = 0.012). Participants with early cognitive impairment had a higher risk of poor outcome (OR, 4.315; 95% CI, 1.503–12.393; p = 0.005) than those without. Furthermore, there was a significantly faster functional recovery rate for those without early cognitive impairment compared with those with at 3 and 6 months (p < 0.05).InterpretationEarly cognitive impairment was prevalent and associated with poor outcomes in ICH patients, which decelerated short‐term functional recovery.

Risk factors and predictive markers of post-stroke cognitive decline–A mini review

“…With posterior circulation structures, a study found significant cognitive impairment in patients with cerebellar infarcts; specifically a higher incidence of significant impairment with right cerebellar lesions showing significantly impaired executive function ( Liu et al, 2022 ). Similar correlations in intracerebral hemorrhage location and resultant cognitive impairment post-stroke were observed in a prospective study that found a strong correlation where patients with lobar hematoma were 4.58 times more likely than patients with non-lobar ICH ( Li et al, 2023 ). Further correlation localizing areas where cognitive impairment is significant would potentially be beneficial for making post-stroke care more individualized.…”

“…A retrospective study that enrolled 184 ICH patients showed as high as 84% of patients developed cognitive decline after hemorrhage ( Banerjee et al, 2018 ). Another recent prospective study published in 2023 identified early cognitive impairment as prevalent among ICH patients and significantly decelerated the recovery of functional outcomes in patients ( Li et al, 2023 ). As a result, in ICH patients, conducting early cognitive assessments will also be crucial in formulating personalized predictions, targeted interventions, and rehabilitation strategies.…”

Intracerebral Hemorrhage Prognosis Classification via Joint-Attention Cross-Modal Network

“…Should these models perform sub-optimally on certain tasks, the efficacy of our methodology could be compromised. Lastly, our model integrated CT imaging data and text, which has been demonstrated to influence prognosis classification outcomes, such as gender [ 27 , 28 , 29 ], early cognitive status [ 30 ], and the location and volume of the hemorrhage [ 31 , 32 ]. Therefore, any loss of information between modalities might impair the model’s performance.…”