The factors that predict cognitive decline after intracerebral haemorrhage (ICH) might already be present at the time of the event, according to a new report in Stroke. The prospective study, which was led by Charlotte Cordonnier in Lille, France, is thought to be the first to longitudinally assess cognitive decline after ICH.

Cordonnier and her colleagues recruited 167 ICH survivors from the PITCH (Prognosis of Intra-Cerebral Hemorrhage) cohort, none of whom had pre-existing dementia. The participants were invited to attend follow-up appointments 6 months and 12 months after ICH, and at yearly intervals thereafter. The Mini-Mental State Examination (MMSE) was used to assess cognitive function at each follow-up visit.

Changes in MMSE score were compared with various baseline parameters, including previous stroke or transient ischaemic attack (TIA), pre-existing cognitive impairment, microbleeds, white matter hyperintensities, and cortical atrophy. Given the difficulty of obtaining a reliable MMSE score in the immediate aftermath of an ICH, the 6-month score was taken as the baseline value.

... cognitive decline after ICH is part of an ongoing process rather than being triggered by the ICH event ...

Over the follow-up period (median 4 years), 37% of the participants exhibited cognitive decline. Previous stroke or TIA, pre-existing cognitive impairment, and severity of cortical atrophy were all found to be independently associated with cognitive decline. If patients with pre-existing cognitive impairment were excluded from the analysis, however, cortical atrophy was the only prognostic factor that remained statistically significant.

The researchers acknowledge a number of limitations to their study. For example, the validity of the MMSE as a measure of cognitive function is open to question. In addition, the inclusion criteria stipulated that each participant must have undergone at least two MMSE assessments, and the patients' ability to complete the MMSE could have been related to the severity of cognitive impariment.

The new findings indicate that cognitive decline after ICH is part of an ongoing process rather than being triggered by the ICH event itself. The authors highlight the importance of thorough assessment when a patient is admitted to hospital with an ICH, so as to identify factors that might influence cognitive function in the long term.