Traumatic Intracerebral Hemorrhage Confers a Higher Risk for Dementia than Spontaneous Intracerebral Hemorrhage
Farid Radmanesh1, Zabreen Tahir1, Taha Yahya1, Winnie Li1, Hadi Abou El Hassan1, Samuel Snider1, Saef Izzy1
1Brigham and Women's Hospital
Objective:
To compare the risk of dementia in young patients with traumatic versus spontaneous intracerebral hemorrhage (ICH).
Background:
Survivors of ICH are at increased risk of cognitive decline. We hypothesize that the risk of dementia differs in traumatic compared to spontaneous ICH.
Design/Methods:
Retrospective cohort study (2000-2018) of patients with ICH, between age 20-60 years, followed for 10 years. Traumatic and spontaneous ICH, and other phenotypes were determined using the ICD codes. Patients with preexisting dementia or the diagnosis made within 6 months after ICH were excluded. Cox proportional hazards and logistic regression models were used to assess the risk and predictors of dementia, respectively.
Results:
Out of 8733 patients with ICH, 2995 (34%) were traumatic and 5738 (66%) were spontaneous. Patients with traumatic ICH were younger (median 46 years [IQR 34-54]; p<0.001) than patients with spontaneous ICH (median 49 years [IQR 41-55]). The 10-year cumulative incidence of dementia after spontaneous ICH was 1.3% compared to 2.1% after traumatic ICH (p=0.002). There was no significant difference between time interval before dementia in two groups (p=0.47). The risk of dementia after traumatic ICH was higher than spontaneous ICH (HR 1.5 [95% CI 1.1-2.2]; p=0.02). The predictors of dementia using multivariable logistic regression include, thyroid disorders (HR 2.7 [95% CI 1.2-5.5]), depression (HR 1.6 [95% CI 1.1-2.4]), and alcohol misuse (HR 1.8 [95% CI 1.1-2.7]).
Conclusions:
Patients with ICH, particularly those secondary to brain trauma, are at increased risk of cognitive decline at relatively young age. These data highlight the long-term complications of acute brain injuries and, the importance of preventative measures and risk reduction strategies.