Abstract 174: MRI Findings Associated with Neurocognitive Impairment One Year after Primary Intracerebral Hemorrhage in a Predominantly Black Cohort

Abstract

Background: We previously reported racial differences in neurocognitive outcomes assessed 1 year after primary ICH in the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) study.. We now analyze MR imaging findings associated with cognitive impairment in this cohort. Methods: Inclusion criteria were primary ICH, age >18, MRI at baseline, neurocognitive outcomes measured at 30 days and 1 year. Domains assessed included memory, executive function, attention, verbal fluency, depression and functional outcome. African American normative data were used to establish cut-points. The following variables were evaluated on MRI: evidence of prior stroke, hemorrhage volume and location, presence of microbleeds, and severity of white matter disease (WMD). Independent t- tests, chi-square, or Fisher’s exact tests were used as appropriate to compare differences between groups at 30 days and 1 year. Results: Of 192 subjects enrolled, mean age was 59 ± 13 years, 47% were female, and 76 % were black. Mean NIHSS was 10 (median 7). Neurocognitive outcomes were available for 144 subjects at 30 days and 126 at 1 year. Significant impairment was observed for all domains at each interval: memory (30 days 90%, 1 year 86%), verbal fluency (30 days 83%, 1 year 74%), attention (30 days 50%, 1 year 52%), and executive function (30 days 51%, 1 year 54%). Dementia was present in 22% at 30 days and 13% at 1 year. At 1 Year, hemorrhage location was not significantly associated with cognitive impairment, however, evidence of prior stroke was associated with impaired executive function (p<0.02). The presence of microbleeds was associated with impaired verbal fluency (p<.03) and executive function (p<.04).White matter disease had the greatest impact on neurocognitive and functional outcomes, with WMD scores >6 associated with impaired memory (p<0.004), executive function (p=0.01) ,verbal fluency (p=0.03), attention (p=0.03) and mRS scores > 2 (p<.005). Conclusion: While the overall rates of neurocognitive and functional impairment decreased over time significant effects of primary ICH persist at 1 year and are associated with MR imaging findings of underlying vascular small vessel injury, including the presence of microbleeds and white matter disease.