医学
蒙特利尔认知评估
脑出血
脑室出血
认知
睡眠剥夺对认知功能的影响
析因分析
随机对照试验
内科学
麻醉
认知障碍
蛛网膜下腔出血
精神科
怀孕
生物
遗传学
胎龄
作者
Vasileios‐Arsenios Lioutas,Aristeidis H. Katsanos,Ashkan Shoamanesh,Farhaan Vahidy,Elizabeth Heistand,Lydia D. Foster,Sharon D. Yeatts,Magdy Selim
出处
期刊:Cerebrovascular Diseases
[S. Karger AG]
日期:2024-04-05
卷期号:: 1-9
摘要
<b><i>Introduction:</i></b> The impact of intracerebral hemorrhage (ICH) on cognition and the determinants of cognitive recovery early after ICH remain elusive. In this post hoc analysis of the intracerebral hemorrhage deferoxamine (iDEF) trial, we examined the trajectories of cognitive impairment and the determinants of early cognitive recovery after ICH. <b><i>Methods:</i></b> We examined baseline factors associated with a 90-day cognitive outcome and constructed generalized linear mixed models to examine the trajectory of cognitive function over time among iDEF participants. Cognition was measured by the Montreal Cognitive Assessment (MoCA) scores on days 7, 30, and 90. <b><i>Results:</i></b> 291 were available for analysis under the trial’s modified intention-to-treat definition (38% female, mean age 60.3 ± 12.0 years, median NIHSS 13, IQR 8–18). The median baseline ICH volume was 12.9 IQR (6.4–26.0) mL; 59 (20%) of the ICH cases were lobar, 120 (41%) had intraventricular extension. There was an overall significant increase in total MOCA score with time (<i>p</i> < 0.0001). Total MOCA score increased by an estimated 3.9 points (95% CI: 3.1, 4.7) between the day 7 and day 30 assessments and by an additional 2.9 points (95% CI: 2.2, 3.6) between the day 30 and day 90 assessments. Despite the overall improvement, 134 of 205 (65%) patients with an available 90-day MoCA score remained cognitively impaired with a score <26 on day 90. Older age, higher NIHSS score, baseline ICH volume, intraventricular hemorrhage, and perihematoma edema had an adjusted negative impact on cognitive recovery. <b><i>Conclusions:</i></b> Although ICH survivors exhibit significant improvement of cognitive status over the first 3 months, cognitive performance remains impaired in the majority of patients. Among factors independently associated with worse cognitive recovery, higher baseline ICH, intraventricular blood and perihematomal edema volumes, are potential therapeutic targets that merit further exploration.
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