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Dementia is strongly associated with 90-day mortality in lobar cerebral amyloid angiopathy related intra-cerebral haemorrhage

Published:August 09, 2012DOI:https://doi.org/10.1016/j.jns.2012.07.047

      Abstract

      Background

      While evidence suggests that lobar intracerebral haemorrhage (ICH) is linked with dementia and cognitive impairment, the association between cognition and mortality risk from ICH is unclear.

      Aims

      To examine the association between dementia or cognitive impairment and short- and medium-term mortality post ICH.

      Methods

      Patients with primary ICH were classified into lobar and non-lobar ICH using radiological criteria. Patients' characteristics and radiological measures were collected at the baseline along with history of dementia and cognitive impairment. Mortality risks at 7, 30, 60, and 90 days were assessed using multiple logistic regression adjusting for potential confounders identified as significant associates in univariate models.

      Results

      A total of 136 patients (males 50%, mean age 77 years, SD 10) were included in this study. Out of 53 (39%) patients with lobar ICH 47 (89%) were classified as having possible and 6 (11%) as probable cerebral amyloid angiopathy (CAA). In lobar ICH the prevalence of history of dementia or cognitive impairment, confusion at presentation, previous ICH, multiple haemorrhages, and initial haematoma volume were significantly higher (p<0.05). In lobar ICH the significant mortality predictors (p<0.05) were history of dementia or cognitive impairment (90 days), prior antiplatelet use (60 and 90 days), initial haematoma volume (60 days), male sex (30 and 60 days), age (30, 60, 90 days), and low Glasgow Coma Scale (GCS) (7 and 30 days). In non-lobar ICH prior use of anticoagulation, initial haematoma volume, low GCS and age were significant mortality predictors (p<0.05).

      Conclusion

      A history of dementia or cognitive impairment is more common in lobar CAA-related ICH and it is a medium-term mortality predictor in lobar ICH but not in deep non-lobar ICH.

      Keywords

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      References

        • Andersen K.
        • Lolk A.
        • Martinussen T.
        • Kragh-Sørensen P.
        Very mild to severe dementia and mortality: a 14-year follow-up: the Odense study.
        Dement Geriatr Cogn Disord. 2010; 29: 61-67
        • Biffi A.
        • Halpin A.
        • Towfighi A.
        • Gilson A.
        • Busl K.
        • Rost N.
        • et al.
        Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy.
        Neurology. 2010; 75 ([24]): 693-698
        • Brainin M.
        • Bornstein N.
        • Boysen G.
        • Demaerin V.
        Acute neurological stroke care in Europe: results of the European Stroke Care Inventory.
        Eur J Neurol. 2000; 7: 5-10
        • Chao C.P.
        • Kotsenas A.L.
        • Broderick D.F.
        Cerebral amyloid angiopathy: CT and MR imaging findings.
        Radiographic. 2006; 26: 1517-1531
        • Cordonnier C.
        • Leys D.
        • Dumont F.
        • Deramecourt V.
        • Bordet R.
        • Pasquier F.
        • et al.
        What are the causes of pre-existing dementia in patients with intracerebral haemorrhages?.
        Brain. 2010; 133: 3281-3289
        • Dennis M.S.
        Outcome after brain haemorrhage.
        Cerebrovasc Dis. 2003; 16: 9-13
        • Fazekas F.
        • Barkhof F.
        • Wahlund L.O.
        • Pantoni L.
        • Erkinjuntti T.
        • Scheltens P.
        • et al.
        CT and MRI rating of white matter lesions.
        Cerebrovasc Dis. 2002; 13: 31-36
        • Flaherty M.L.
        • Haverbusch M.
        • Sekar P.
        Long term mortality after intracerebral haemorrhage.
        Neurology. 2006; 66: 1182-1186
        • Greenberg S.M.
        • Eng J.A.
        • Ning M.
        • Smith E.E.
        • Rosand J.
        Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage.
        Stroke. 2004; 35: 1415-1420
        • Hu X.
        • Zhang J.H.
        • Qin X.
        Risk factors of early death in patients with hypertensive intracerebral hemorrhage during hospitalization.
        Acta Neurochir Suppl. 2011; 111: 387-391
        • Jackson C.A.
        • Sudlow C.L.
        Is hypertension a more frequent risk factor for deep than for lobar supratentorial intracerebral haemorrhage?.
        J Neurol Neurosurg Psychiatry. 2006; 77: 1244-1252
        • Knudsen K.A.
        • Rosand J.
        • Karluk D.
        • Greenberg S.M.
        Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria.
        Neurology. 2001; 56: 537-539
        • Kothari R.U.
        • Brott T.
        • Broderick J.P.
        • Barsan W.G.
        • Sauerbeck L.R.
        • Zuccarello M.
        • et al.
        The ABCs of measuring intracerebral hemorrhage volumes.
        Stroke. 1996; 27: 1304-1305
        • Kuramatsu J.B.
        • Sauer R.
        • Mauer C.
        • Lucking H.
        • Kloska S.
        • Kiphuth I.C.
        • et al.
        Correlation of age and haematoma volume in patients with spontaneous lobar intra-cerebral haemorrhage.
        J Neurol Neurosurg Psychiatry. 2011; 82: 144-149
        • Kwok C.S.
        • Skinner J.
        • Metcalf A.K.
        • Potter J.F.
        • Myint P.K.
        Prior antiplatelet or anticoagulant therapy and mortality in stroke.
        Heart. 2012; 98: 712-717
        • Lovelock C.E.
        • Molyneux A.J.
        • Rothwell P.M.
        Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006: a population-based study.
        Lancet Neurol. 2007; 6: 487-493
        • Russ T.C.
        • Shenkin S.D.
        • Reynish E.
        • Ryan T.
        • Anderson D.
        • MacLullich A.M.J.
        Dementia in acute hospital inpatients: the role of geriatrician.
        Age and Ageing. 2012; 41: 282-284
        • Sampson E.L.
        • Blanchard M.R.
        • Jones L.
        • Tookman A.
        • King M.
        Dementia in the acute hospital: prospective cohort study of prevalence and mortality.
        Br J Psychiatry. 2009; 195: 61-66
        • Smith E.E.
        • Greenberg S.M.
        Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria.
        Current Atherosclerosis Reports. 2003; 4: 260-266
        • Thompson B.B.
        • Béjot Y.
        • Caso V.
        • Castillo J.
        • Christensen H.
        • Flaherty M.L.
        • et al.
        Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review.
        Neurology. 2010; 12 ([15]): 1333-1342
        • Zia E.
        • Hedblad B.
        • Pessah-Rasmussen H.
        • Berglund G.
        • Janzon L.
        • Engström G.
        Blood pressure in relation to the incidence of cerebral infarction and intracerebral hemorrhage. Hypertensive hemorrhage: debated nomenclature is still relevant.
        Stroke. 2007; 38: 2681-2685