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. 2017 Jun 1;12(6):e0178886.
doi: 10.1371/journal.pone.0178886. eCollection 2017.

High prevalence of cognitive impairment after intracerebral hemorrhage

Mélanie Planton  1   2 , Laure Saint-Aubert  3 , Nicolas Raposo  1   2 , Laura Branchu  2 , Aicha Lyoubi  4 , Fabrice Bonneville  2   5 , Jean-François Albucher  1   2 , Jean-Marc Olivot  1   2 , Patrice Péran  2 , Jérémie Pariente  1   2
Affiliations

High prevalence of cognitive impairment after intracerebral hemorrhage

Mélanie Planton et al. PLoS One. .

Abstract

Background: Cognitive impairment seems to be frequent in intracerebral hemorrhage (ICH) survivors, but remains widely understudied. In this study, we investigated the frequency and patterns of vascular cognitive disorders (VCDs) in patients with cerebral amyloid angiopathy (CAA)-related and deep ICH compared to patients with mild cognitive impairment due to Alzheimer's disease (MCI-AD) and healthy controls.

Methods: We prospectively recruited 20 patients with CAA-related lobar ICH, 20 with deep ICH, 20 with MCI-AD and 17 healthy controls. Patients with cognitive decline pre-ICH were excluded from the analysis. Each participant underwent a comprehensive neuropsychological assessment and a structural brain MRI. Cognitive assessment was performed at a median delay of 4 months after the acute phase in ICH patients, and more than 6 months after the first complaint in MCI-AD patients. Cognitive profiles were compared between groups. The prevalence of VCDs in the ICH groups was estimated using the recent VASCOG criteria.

Results: "Mild" and "major VCDs" were respectively observed in 87.5% and 2.5% of all ICH patients. Every patient in the CAA group had mild VCDs. No significant difference was observed in cognitive functioning between CAA-related and deep ICH patients. The most impaired process in the CAA group was naming, with a mean (±standard deviation) z-score of -5.2 ±5.5, followed by processing speed (-4.1±3.3), executive functioning (-2.6 ±2.5), memory (-2.4 ±3.5) and attention (-0.9 ±1.3). This cognitive pattern was different from the MCI-AD patients, but the groups were only different in gestural praxis, and by construction, in memory processes.

Conclusions: VCDs are frequent after ICH. Cognitive patterns of patients with deep or CAA-related ICH did not differ, but there was impaired performance in specific domains distinct from the effects of Alzheimer's disease.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01619709.

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Conflict of interest statement

Competing Interests: All authors report no disclosures except Prof. JM Olivot. Disclosure JMO: Consulting for Astra Zeneca, Boston Scientific, Servier; Speaker fee and travel expenses: Boehringer Ingelheim, Bristol Myers Squibb and Pfizer. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow chart for patients selection.
Fig 2
Fig 2. Intracerebral hemorrhage lesion maps.
A. Lesion map of CAA-related ICH group. B. Lesion map of deep ICH group. Units on color scale represent number of patients with a lesion in each area.
Fig 3
Fig 3. Comparison among patient groups in cognitive profiles expressed as z-scores.
The diamond symbols represent the mean z-score value for the group, and error bars represent standard errors. The red line represents the threshold of 2 standard deviations from the mean performance of healthy controls.
See this image and copyright information in PMC

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