Spontaneous, non-traumatic intracerebral hemorrhage (ICH) refers to bleeding within the brain parenchyma that occurs in the absence of trauma and carries significant morbidity and mortality. While a close association has been identified between stroke and dementia, available literature primarily focuses on post-stroke dementia in ischemic stroke patients, and there are few clinical studies evaluating cognitive dysfunction post-ICH. The present systematic review and meta- analysis analyzes the available clinical literature on post-ICH cognitive impairment.
We conducted a systematic review with meta-analysis following PRISMA guidelines. A search of bibliographic databases up to July 31, 2020 yielded a total of 2155 studies. Twenty articles were included in our final qualitative systematic review and 18 articles in quantitative meta-analysis.
Based on analysis of data from 18 studies (3270 patients), we found prevalence of post-ICH cognitive impairment to be 46% (CI, 35.9-55.9) with a follow-up duration ranging from 8 days to 4 years. The estimated pooled prevalence of cognitive decline decreased over longitudinal follow- up, from 55% (range 37.7-71.15%) within 6 months of ICH to 35% (range 27-42.7%) with > 6 months to 4 years follow-up post-ICH. The modalities used to evaluate cognitive performance post-ICH in studies varied widely, ranging from global cognitive measures to domain-specific testing. The cognitive domain most commonly affected included non-verbal IQ, information processing speed, executive function, memory, language and visuo-constructive abilities. Prognostic factors for poor cognitive performance included severity of cortical atrophy, age, lobar ICH location, and higher number of hemorrhages at baseline.
The prevalence of post-ICH cognitive impairment is high. Despite the heterogeneity among studies, the present study identified cognitive domains most commonly affected and predictors of cognitive impairment post-ICH. In future, prospective cohort studies with larger sample sizes and standardized cognitive domains testing could more accurately determine prevalence and prognostic factors of post-ICH cognitive decline.
Kazim, Syed Faraz; Jonathan V. Ogulnick; Myranda B. Robinson; Javed Khader Eliyas; Benjamin Q. Spangler; Tyler J. Hough; Erick Martinez; Zafar Karimov; Devan W. Vidrine; Meic H. Schmidt; and Christian A. Bowers. "Cognitive impairment after intracerebral hemorrhage: a systematic review and meta-analysis." (2021). https://digitalrepository.unm.edu/hsc-bbhrd/18