Prognostic factors for cognitive decline after intracerebral haemorrhage

Background and purpose: Stroke and dementia are closely related, but no prospective study ever focused on post-stroke cognitive decline in patients with intracerebral haemorrhage (ICH). We aimed to determine prognostic factors for cognitive decline in ICH patients. Methods: We prospectively included 167 consecutive ICH survivors without pre-existing dementia from the Prognosis of InTra-Cerebral Haemorrhage (PITCH) cohort. Median follow-up was 4 years (interquartile range [IQR]: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 (MMSE). 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 pre-existing cognitive impairment. Results: Median age was 64 (IQR: 53-75) years, 69 (41%) patients were female and median MMSE at 6 months was 27 (IQR: 23-29). Overall, 37% of the patients declined during follow-up. Factors associated with cognitive decline in univariate analyses were: previous stroke or TIA, pre-existing cognitive impairment, microbleed presence, severity of white matter hyperintensities, and severity of cortical atrophy. In multivariable analyses, previous stroke or TIA (β [SE]-0.55[0.23], p<0.05), pre-existing 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 pre-existing 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.