Abstract 3096: Poor Neurocognitive Outcomes in a Longitudinal Study of Primary Intracerebral Hemorrhage

Abstract

Background: Performance on neurocognitive outcomes in patients with primary intracerebral hemorrhage (ICH) has not been well described, particularly in black populations. We sought to characterize neurocognitive performance at 30 days and 1 year in ICH patients enrolled in the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) Project. Methods: Inclusion criteria were: primary ICH, age ≥ 18. Neurocognitive outcomes were assessed at 30 days, and 1 year. Domains assessed were: memory, executive function, verbal fluency, depression, and functional outcome. African American norms were used to establish cut-points. Independent t-tests were used to examine differences by race; paired t-tests were used to compare changes in performance between 30 days and 1 year, and p values were corrected for multiple comparisons. Results: Of 162 subjects enrolled, mean age was 59±13 years, 44% were female, 75% were black. Mean admission NIH Stroke Scale score was 9 (median 6). Neurocognitive outcomes were available for 142 subjects at 30 days and 100 subjects at 1 year. Significant impairment was observed for all domains at each interval: memory (30 days 88%, 1 year 84%); verbal fluency (30 days 84%, 1 year 84%); attention (30 days 51%, 1 year 49%), and executive function (30 days 52%, 1 year 51%). Depression was observed in 44% at 30 days and 38% at 1 year. Functional impairment (mRS > 2) was found in 46% at 30 days and 40% at 1 year. Twenty one percent screened positive for dementia at 30 days and 13% at 1 year. Blacks had significantly lower scores at 30 days for memory (p<0.04), verbal fluency (p<0.05), and attention (p<0.02), while whites had higher depression scores (p<0.03). No racial differences were observed at year 1. While the average scores improved for all neurocognitive measures between 30 days and 1 year for the 87 subjects with longitudinal data, improvements were greatest for attention (p<0.001) and executive function (p<0.01). Conclusions: Significant impairments in all neurocognitive domains were observed at both 30 days and 1 year in this population of ICH subjects. Blacks had greater cognitive impairment and less depression at 30 days, however, these differences were no longer present at 1 year. While performance improved over time, significant impairment in memory, attention, fluency, and executive function persisted at 1 year.