JNNP: Long-term neuropsychiatric symptoms in patients with spontaneous cerebral hemorrhage

Neuropsychiatric (NP) symptoms are prominent features of neurodegenerative diseases and cognitive decline, and are very common in all stages of dementia
.

It seems that NP symptoms can also predict the development of cognitive impairment and the transition from mild cognitive impairment to dementia in the cognitively normal elderly

A recent study of patients with all types of stroke found that in a small subgroup of ICH, the incidence of behavioral disorders is higher

In dementia patients, the presence of NP symptoms is related to the worse functional status and quality of life of patients and caregivers
.

The identification of NP symptoms may affect care plans and prevention strategies to reduce the burden of cognitive and functional status of ICH survivors

This article aims to determine the prevalence and predictors of NP symptoms 6 months after ICH in a large cohort of ICH patients

The data of patients with continuous spontaneous intracerebral hemorrhage registered in the "Prognosis of Intracerebral Hemorrhage" (PITCH) cohort from November 2004 to March 2009 were analyzed.
These patients were alive at 6 months and could be assessed by NP
.

Collect baseline demographic characteristics, vascular risk factors, and stroke history (ischemic or hemorrhagic)

Patient selection process

The NP assessment was performed by neurologists 6 months after cerebral hemorrhage using the Neuropsychiatric Questionnaire (NPI-Q)
.

NPI-Q is a tool that can quickly assess NP symptoms based on information

The NP assessment was performed by neurologists 6 months after cerebral hemorrhage using the Neuropsychiatric Questionnaire (NPI-Q)

Neuropsychiatric (NP) symptoms appear 6 months after cerebral hemorrhage

All patients in the study underwent CT scans on admission
.

ICH is divided into brain lobes and non-brain lobes, the latter also includes brain stem and cerebellar hemorrhage

All patients in the study underwent CT scans on admission

Neuropsychiatric (NP) characteristics according to intracerebral hemorrhage (ICH) subtype and cognitive status

 

Among 560 patients with cerebral hemorrhage, 265 survived at 6 months
.

It is feasible to evaluate 202 patients with NP 6 months after cerebral hemorrhage

Among 560 patients with cerebral hemorrhage, 265 survived at 6 months
.
It is feasible to evaluate 202 patients with NP 6 months after cerebral hemorrhage
.
Among 560 patients with cerebral hemorrhage, 265 survived at 6 months
.
It is feasible to evaluate 202 patients with NP 6 months after cerebral hemorrhage
.

More than half of 6-month ICH survivors have symptoms of NP
.
Patients with dementia after intracerebral hemorrhage are three times more likely to develop NP symptoms
.
Affective symptoms are the most common disorder, followed by autonomic and hyperkinetic symptoms
.
More severe cerebral hemorrhage at the onset of cerebral hemorrhage is related to the appearance of NP symptoms after cerebral hemorrhage
.
The severity of NP symptoms is independently related to CAA MRI findings and pre-ICH disability
.
Hyperactivity and apathy are more common in patients with dementia after intracerebral hemorrhage, while emotional symptoms are more common in patients with dementia after intracerebral hemorrhage
.
In the survival analysis, the presence and severity of NP symptoms were not related to the increase in long-term mortality and dementia
.
The difference is that specific NP characteristics (indifference and hyperactivity relative to affective symptoms) are associated with an increased risk of developing long-term new-onset dementia
.
Overall, this study is the first attempt to investigate the symptoms of NP in patients with cerebral hemorrhage
.
In this case, timely identification of NP symptoms can improve care planning and has clinical significance for long-term ICH management
.

More than half of 6-month ICH survivors have symptoms of NP
.
Patients with dementia after intracerebral hemorrhage are three times more likely to develop NP symptoms
.
Affective symptoms are the most common disorder, followed by autonomic and hyperkinetic symptoms
.
More severe cerebral hemorrhage at the onset of cerebral hemorrhage is related to the appearance of NP symptoms after cerebral hemorrhage
.
More than half of 6-month ICH survivors have symptoms of NP
.
Patients with dementia after intracerebral hemorrhage are three times more likely to develop NP symptoms
.
Affective symptoms are the most common disorder, followed by autonomic and hyperkinetic symptoms
.
More severe cerebral hemorrhage at the onset of cerebral hemorrhage is related to the appearance of NP symptoms after cerebral hemorrhage
.

The results indicate that vascular amyloid deposits may affect the performance of NP in ICH patients
.
In this cohort study, single SVD markers such as WMH, brain atrophy and cSS were not related to the presence and severity of NP symptoms
.
The distribution of NP varies with cognitive status, ICH location, and major SVD subtypes (CAA and non-CAA)
.
In fact, patients with dementia after intracerebral hemorrhage, lobe intracerebral hemorrhage location, and CAA MRI manifestations generally have similar NP manifestations
.
Apathy and hyperactivity are more frequent in patients with dementia after ICH, while affective symptoms are more frequent in patients with dementia after non-ICH
.
It can be inferred that the overall similarity between NP characteristics, lobe intracerebral hemorrhage and CAA-MRI characteristics of dementia patients after intracerebral hemorrhage is related to the parenchymal damage caused by the cumulative load of the lesion caused by CAA
.
In the age-adjusted survival analysis, the presence and severity of NP symptoms correlated with long-term mortality, although this finding may be driven by co-existing dementia, because these correlations were not confirmed after adjusting for post-ICH dementia
.
The difference is that the existence and severity of NP symptoms have nothing to do with long-term new-onset dementia
.

The results indicate that vascular amyloid deposits may affect the performance of NP in ICH patients
.
In this cohort study, single SVD markers such as WMH, brain atrophy and cSS were not related to the presence and severity of NP symptoms
.
The results indicate that vascular amyloid deposits may affect the performance of NP in ICH patients
.
In this cohort study, single SVD markers such as WMH, brain atrophy and cSS were not related to the presence and severity of NP symptoms
.

More than half of 6-month ICH survivors have symptoms of NP, and the prevalence and severity of dementia after ICH are higher
.
The unique characteristics of NP may be related to cognitive status and suggest long-term dementia risk
.

Scopelliti  G ,  Casolla  B ,  Boulouis  G Scopelliti  GScopelliti Casolla  BCasolla Boulouis  GBoulouis, et alJournal of Neurology, Neurosurgery & Psychiatry  Published Online First:  02 November 2021.
 Published Online First: doi:  10.
1136/jnnp-2021-327557doi:Leave a message here