Abstract
BackgroundCognitive impairment and depressive symptoms are highly prevalent after Intracerebral Hemorrhage (ICH). We leveraged Latent Profile Analysis (LPA) to identify profiles for cognitive decline and depression onset after ICH. We also investigated differences in clinical, genetic and neuroimaging characteristics across patients’ profiles.MethodsWe analyzed data from the ICH study conducted at Massachusetts General Hospital between January 1998 and December 2019. We collected information from electronical health records, follow-up interviews, CT and MRI imaging, and APOE genotype. We conducted LPA and multinomial logistic regression analyses to: 1) identify distinct profiles for cognitive decline and depression onset after ICH; 2) identify clinical, neuroimaging and genetic factors predicting individuals’ likelihood to express a specific profile.ResultsWe followed 784 ICH survivors for a median of 45.8 months. We identified four distinct profiles in cognitive and depressive symptoms after ICH: low depression and dementia risk, early-onset depression and dementia, late-onset depression and dementia, high depression with low dementia risk. Cerebral small vessel disease severity and APOE genotype were specifically associated with the late-onset profile (both p < 0.05). Acute hematoma characteristics (size, intraventricular extension) and functional disability were specifically associated with the early-onset profile (all p < 0.05).ConclusionWe identified four distinct profiles for cognitive and depressive symptoms after ICH, each displaying specific associations with individual patients’ clinical, genetic and neuroimaging data. These associations reflect separate biological mechanisms influencing dementia and depression risk after ICH. Our findings support employing LPA in future ICH studies, and is likely applicable to stroke survivors at large.
Highlights
Survivors of Intracerebral Hemorrhage (ICH) are at high risk for cognitive decline following the acute hemorrhage event, with up to 40% of patients developing dementia within 5 years [1]
Most primary ICH events represent an acute manifestation of underlying cerebral small vessel disease (CSVD), a progressive degenerative disorder of small calibers arterioles in the central nervous system [7]
Multicollinearity was assessed by computing Variance Inflation Factors (VIF) for all predictors and removing all variables with VIF > 5
Summary
Survivors of Intracerebral Hemorrhage (ICH) are at high risk for cognitive decline following the acute hemorrhage event, with up to 40% of patients developing dementia within 5 years [1]. Keins et al BMC Neurology (2021) 21:481 decline and depression onset are both associated with poor long-term functional outcomes following stroke in general, and ICH in particular [4,5,6,7,8]. Acute hemorrhage characteristics (e.g. size, anatomical location) are associated with cognitive decline and depression risk after hemorrhagic stroke [8, 10]. CSVD is associated with increased risk for depression and cognitive decline, both in the general population and among ICH survivors [5, 13]. Cognitive impairment and depressive symptoms are highly prevalent after Intracerebral Hemorrhage (ICH). We investigated differences in clinical, genetic and neuroimaging characteristics across patients’ profiles
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