0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Risk Factors Associated With Early vs Delayed Dementia After Intracerebral Hemorrhage

Alessandro Biffi, MD1,2,3,4,5; Destiny Bailey, BS1,2; Christopher D. Anderson, MD, MMSc1,2,3,6,7; Alison M. Ayres, BA2; Edip M. Gurol, MD2,6; Steven M. Greenberg, MD, PhD2,6; Jonathan Rosand, MD, MSc1,2,3,6,7; Anand Viswanathan, MD, PhD2,6
[+] Author Affiliations
1Center for Human Genetic Research, Massachusetts General Hospital, Boston
2J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston
3Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
4Division of Stroke, Department of Neurology, Massachusetts General Hospital, Boston
5Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston
6Division of Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Boston
7Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston
JAMA Neurol. 2016;73(8):969-976. doi:10.1001/jamaneurol.2016.0955.
Text Size: A A A
Published online

Importance  Patients who have experienced intracerebral hemorrhage (ICH) appear to develop cognitive impairment at high rates, both early after ICH and over the long term.

Objective  To identify and compare risk factors for early and delayed dementia after ICH.

Design, Setting, and Participants  A longitudinal study enrolled patients who had experienced ICH from January 1, 2006, to December 31, 2013. A total of 738 participants 18 years or older, without pre-ICH dementia, who presented to a tertiary care academic institution with primary ICH were included in the analyses of early post-ICH dementia (EPID). After accounting for incident dementia and mortality at 6 months, 435 participants were included in the analyses of delayed post-ICH dementia (DPID).

Exposures  Intracerebral hemorrhage.

Main Outcomes and Measures  Cognitive performance was captured using the modified Telephone Interview for Cognitive Status test. Outcomes included EPID, diagnosed within 6 months after ICH, and DPID, diagnosed beyond 6 months after ICH.

Results  Among 738 patients who had experienced ICH (mean [SD] age, 74.3 [12.1] years; 384 men [52.0%]), 140 (19.0%) developed dementia within 6 months. A total of 435 patients without dementia at 6 months were followed up longitudinally (median follow-up, 47.4 months; interquartile range, 43.4-52.1 months), with an estimated yearly incidence of dementia of 5.8% (95% CI, 5.1%-7.0%). Larger hematoma size (hazard ratio [HR], 1.47 per 10-mL increase; 95% CI, 1.09-1.97; P < .001 for heterogeneity) and lobar location of ICH (HR, 2.04; 95% CI, 1.06-3.91; P = .02 for heterogeneity) were associated with EPID but not with DPID. Educational level (HR, 0.60; 95% CI, 0.40-0.89; P < .001 for heterogeneity), incident mood symptoms (HR, 1.29; 95% CI, 1.02-1.63; P = .01 for heterogeneity), and white matter disease as defined via computed tomography (HR, 1.70; 95% CI, 1.07-2.71; P = .04 for heterogeneity) were associated with DPID but not EPID.

Conclusions and Relevance  Incident dementia early after ICH is strongly associated with hematoma size and location. Delayed incident dementia is frequent among patients who have experienced ICH and is not prominently associated with acute characteristics of ICH. These findings suggest the existence of heterogeneous biological mechanisms accounting for early vs delayed cognitive decline among patients who have experienced ICH.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Study Design and Inclusion and Exclusion Criteria

CT indicates computed tomography; ICH, intracerebral hemorrhage; and MRI, magnetic resonance imaging.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Incident Delayed Cognitive Decline Among Patients Experiencing Intracerebral Hemorrhage (ICH)

Cumulative incidence of delayed post-ICH dementia as percentages of total study population. Rates were computed among all study participants who were free of dementia at 6 months. Number of patients alive and being followed up at each time point is listed at the bottom.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

923 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Supplemental Content

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Stroke, Hemorrhagic: Does This Patient Have a Hemorrhagic Stroke?

brightcove.createExperiences();