Prognostic Factors for Cognitive Decline After Intracerebral Hemorrhage.
OBJECTIVE
Stroke and dementia are closely related, but no prospective study ever focused on poststroke cognitive decline in patients with intracerebral hemorrhage (ICH). We aimed to determine prognostic factors for cognitive decline in patients with ICH.


METHODS
We prospectively included 167 consecutive ICH survivors without preexisting dementia from the Prognosis of Intra-Cerebral Hemorrhage (PITCH) cohort. Median follow-up was 4 years (interquartile range, 2.3-5.4). We explored factors associated with cognitive decline using linear mixed models. Cognitive decline was determined based on repeated mini-mental state examination. We investigated each prognostic factor separately in univariate models. Next, we constructed clinical and radiological multivariable models. In a sensitivity analysis, we excluded patients with preexisting cognitive impairment.


RESULTS
Median age was 64 (interquartile range, 53-75) years, 69 (41%) patients were women, and median mini-mental state examination at 6 months was 27 (interquartile range, 23-29). Overall, 37% of the patients declined during follow-up. Factors associated with cognitive decline in univariate analyses were previous stroke or transient ischemic attack, preexisting cognitive impairment, microbleed presence, severity of white matter hyperintensities, and severity of cortical atrophy. In multivariable analyses, previous stroke or transient ischemic attack (β [SE], -0.55 [0.23]; P<0.05), preexisting cognitive impairment (β [SE], -0.56 [0.25]; P<0.01), and severity of cortical atrophy (β [SE], -0.50 [0.19]; P<0.01) remained independent prognostic factors. In patients without preexisting cognitive impairment (n=139), severity of cortical atrophy (β [SE], -0.38 [0.17]; P<0.05) was the only prognostic factor for future cognitive decline.


CONCLUSIONS
Prognostic factors for cognitive decline after ICH are already present when ICH occurs, suggesting a process of ongoing cognitive impairment instead of new-onset decline induced by the ICH itself.
From the Alzheimer Center and Department of Neurology (M.R.B., W.M.v.d.F.) and Department of Epidemiology and Biostatistics (W.M.v.d.F.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; and Department of Neurology, INSERM U 1171, CHRU, University of Lille, Lille, France (A.H., C.R., G.B., H.H., C.C.). charlotte.cordonnier@chru-lille.fr.
Marije R
MR
Benedictus
From the Alzheimer Center and Department of Neurology (M.R.B., W.M.v.d.F.) and Department of Epidemiology and Biostatistics (W.M.v.d.F.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; and Department of Neurology, INSERM U 1171, CHRU, University of Lille, Lille, France (A.H., C.R., G.B., H.H., C.C.).
Anaïs
A
Hochart
From the Alzheimer Center and Department of Neurology (M.R.B., W.M.v.d.F.) and Department of Epidemiology and Biostatistics (W.M.v.d.F.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; and Department of Neurology, INSERM U 1171, CHRU, University of Lille, Lille, France (A.H., C.R., G.B., H.H., C.C.).
Costanza
C
Rossi
From the Alzheimer Center and Department of Neurology (M.R.B., W.M.v.d.F.) and Department of Epidemiology and Biostatistics (W.M.v.d.F.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; and Department of Neurology, INSERM U 1171, CHRU, University of Lille, Lille, France (A.H., C.R., G.B., H.H., C.C.).
Gregoire
G
Boulouis
From the Alzheimer Center and Department of Neurology (M.R.B., W.M.v.d.F.) and Department of Epidemiology and Biostatistics (W.M.v.d.F.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; and Department of Neurology, INSERM U 1171, CHRU, University of Lille, Lille, France (A.H., C.R., G.B., H.H., C.C.).
Hilde
H
Hénon
From the Alzheimer Center and Department of Neurology (M.R.B., W.M.v.d.F.) and Department of Epidemiology and Biostatistics (W.M.v.d.F.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; and Department of Neurology, INSERM U 1171, CHRU, University of Lille, Lille, France (A.H., C.R., G.B., H.H., C.C.).
Wiesje M
WM
van der Flier
From the Alzheimer Center and Department of Neurology (M.R.B., W.M.v.d.F.) and Department of Epidemiology and Biostatistics (W.M.v.d.F.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; and Department of Neurology, INSERM U 1171, CHRU, University of Lille, Lille, France (A.H., C.R., G.B., H.H., C.C.).
Charlotte
C
Cordonnier
D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000523:psychology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
cerebral hemorrhage; dementia; ischemic attack, transient; mild cognitive impairment; stroke