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

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.