Introduction:
Despite emerging evidence, trajectories of cognitive impairment (CI) among patients with spontaneous intracerebral hemorrhage (ICH) are not well characterized.
Methods:
We conducted a systematic review of literature within PubMed, using keywords [“Intracerebral hemorrhage” OR “ICH”] AND “Cognitive Impairment,” after 2010. Articles reporting assessments of post ICH CI were included. Articles limited to pre-clinical (animal) studies, non-English literature, other intracranial hemorrhages, traumatic ICH, narrative reviews, and patient under 18 years were excluded.
Results:
Based on selection criteria, we included 16 articles (graphic) that provide an assessment of post-ICH CI. Post-ICH CI had a reported incidence of up to 85% within the first 2 weeks. The proportion of ICH patients who experience an incident CI across a longer follow up time period have been reported with a high degree of variability; with reports at 3 (32.5 - 71%), 4 (78%), 6 (37 - 63.3%), 9 (47.1 - 100%), 18 (51%), 30 (25.8%), 40 (23%), 45.6 (52 - 64%) and 60 (37.4%) months. Though the assessment scales utilized are variable; 12 (75%) reports employed a version of Montreal Cognitive Assessment or Information Questionnaire on Cognitive Decline in the Elderly. Lobar ICH was well identified, while non-lobar ICHs were variably grouped. Imaging markers have been reported in 10 (62.5%) reports. Though most studies report comorbidities and sociodemographic factors; stroke-specific severity / functional scales and genetic factors have only been considered by 2 (12.5%) articles each.
Conclusions:
At least 1 in 3 ICH survivors experience post-ICH CI over 12 months. There is an overall paucity of data on post-ICH CI, which highlights a critical need to characterize the natural history of post ICH CI in prospective cohorts and develop standardized assessment protocols for CI among ICH patients.
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