The word prognostic immediately tells me this is useless. There is not a survivor in the world who wants prognostication, they want EXACT RECOVERY PROTOCOLS. When the fuck will you get there?
Prognostic Factors for Cognitive Recovery Beyond Early Poststroke Cognitive Impairment (PSCI): A Prospective Cohort Study of Spontaneous Intracerebral Hemorrhage
Li Gong1†, 
Yongzhe Gu1†, 
Qiuyue Yu1, Haichao Wang1, Xiaoping Zhu2,3, Qiong Dong1, Rong Xu4*, Yanxin Zhao1* and 
Xueyuan Liu1*- 1Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
- 2School of Nursing, Second Military Medical University, Shanghai, China
- 3Department of Nursing, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
- 4Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
Background: Post stroke cognitive
impairment (PSCI) has been increasingly recognized in patients, but some
stroke survivors appear to show cognitive improvement beyond the acute
stage. The risk factors associated with cognitive recovery after
spontaneous intracerebral hemorrhage (ICH) onset have not yet been
sufficiently investigated in prospective studies.
Objective: We aimed to identify the
trajectory of post ICH cognitive impairment and the association of
potential prognostic factors with follow-up cognitive recovery beyond
early PSCI.
Methods: In this stroke center-based
cohort study, 141 consecutive dementia-free patients with spontaneous
ICH were included and underwent Montreal Cognitive Assessment (MoCA)
evaluation for cognitive function at baseline (within 2 weeks of ICH
onset) and the shortened MoCA (short-MoCA) at a 6-month follow-up. To
explore the prognostic factors associated with trajectory of cognition
after an ICH onset, we adjusted for demographic and vascular risk
factors, using multivariate logistic regression analysis.
Results: Of the 141 ICH patients,
approximately three quarters (106/141) were diagnosed with early PSCI
(MoCA score <26) within 2 weeks of ICH onset. The multiple logistic
regression indicated independent positive associations between risk of
early PSCI and dominant-hemisphere hemorrhage [odd's ratio (OR): 8.845
(3.347–23.371); P < 0.001], mean corpuscular volume (MCV) [OR: 1.079 (1.002–1.162); P = 0.043], admission systolic blood pressure (sBP) [OR: 1.021 (1.005–1.038); P
= 0.012]. Furthermore, 36% (33/90) of ICH survivors who had early PSCI
exhibited cognitive recovery at the 6-month follow-up. After examining
potential predictors through multiple linear regression based on
stepwise, there were independent negative associations between cognitive
recovery and dominant hemisphere hemorrhage [OR: 6.955 (1.604–30.162); P < 0.01], lobar ICH [OR: 8.363 (1.479–47.290); P = 0.016], years of education ≤ 9 [OR: 5.145 (1.254–21.105); P = 0.023], and MCV [OR: 1.660 (1.171–2.354); P
= 0.004]. Baseline cognitive performance in the domains of
visuospatial/executive function, attention, orientation, and language
showed positive correlations with cognitive improvement (P < 0.05).
Conclusion: In this cohort study of
dementia-free survivors of ICH, our results show that one in three early
PSCI survivors exhibit cognitive recovery, in relation to
dominant-hemisphere hematoma, lobar ICH, educational history, and MCV
levels. Future clinical trials including ICH survivors with cognitive
dysfunction should assess these factors.
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