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
To compare the risk of dementia in young patients with traumatic versus spontaneous intracerebral hemorrhage (ICH).
Survivors of ICH are at increased risk of cognitive decline. We hypothesize that the risk of dementia differs in traumatic compared to spontaneous ICH.
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.
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]).
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.