Cognitive impairment before and after intracerebral haemorrhage: a systematic review



There is increasing interest in understanding cognitive dysfunction before and after Intracerebral haemorrhage (ICH), given the higher prevalence of dementia reported (ranging from 5 to 44%) for this stroke type. Much of the evidence to date examining cognitive impairment associated with cerebrovascular disease has tended to focus more on ischaemic stroke. The aim of this review was to identify and quantify studies that focused on cognitive dysfunction pre and post ICH.


We conducted a systematic search using databases PubMed, Science Direct, Scopus and PsycINFO to identify studies that exclusively assessed cognitive function pre and post ICH. Studies were included in the review if used a measure of global cognition and/or a neuropsychological battery to assess cognitive function. Nineteen studies were deemed relevant for inclusion, where n = 8 studies examined cognitive impairment pre ICH and n = 11 post ICH.


Prevalence of cognitive impairment ranged between 9–29% for pre ICH and 14–88% for post ICH. Predictive factors identified for pre and post ICH were previous stroke, ICH volume and location and markers of cerebral amyloid angiopathy (CAA). Most common cognitive domains affected post ICH were information processing speed, executive function, memory, language and visuo-spatial abilities. Most common cognitive assessments tools were the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) for pre-existing cognitive impairment and the Mini-Mental State Examination for global cognition post ICH and the Trail Making Test where neuropsychological tests were used.


Cognitive impairment and dementia affected almost one-third of patients, whether assessed pre or post ICH.

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  1. 1.

    Aguilar MI, Brott TG (2011) Update in intracerebral hemorrhage. Neurohospitalist 1:148–159

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Domingues R, Rossi C, Cordonnier C (2014) Classification of intracerebral haemorrhages. Eur Neurol Rev 9:129–135

    Google Scholar 

  3. 3.

    Charidimou A, Schmitt A, Wilson D, Yakushiji Y, Gregoire SM, Fox Z, Jager HR, Werring DJ (2017) The Cerebral Haemorrhage anatomical RaTing inStrument (CHARTS): development and assessment of reliability. J Neurol Sci 372:178–183

    PubMed  Google Scholar 

  4. 4.

    DeSimone CV, Graff-Radford J, El-Harasis MA, Rabinstein AA, Asirvatham SJ, Holmes DR Jr (2017) Cerebral amyloid angiopathy: diagnosis, clinical implications, and management strategies in atrial fibrillation. J Am Coll Cardiol 70:1173–1182

    PubMed  Google Scholar 

  5. 5.

    Moulin S, Cordonnier C (2015) Prognosis and outcome of intracerebral haemorrhage. Front Neurol Neurosci 37:182–192

    PubMed  Google Scholar 

  6. 6.

    Charidimou A, Pantoni L, Love S (2016) The concept of sporadic cerebral small vessel disease: a road map on key definitions and current concepts. Int J Stroke 11:6–18

    PubMed  Google Scholar 

  7. 7.

    Finocchi C, Balestrino M, Malfatto L, Mancardi G, Serrati C, Gandolfo C (2018) National Institutes of Health Stroke Scale in patients with primary intracerebral hemorrhage. Neurol Sci 39:1751–1755

    PubMed  Google Scholar 

  8. 8.

    Gottesman RF, Hillis AE (2010) Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. Lancet Neurol 9:895–905

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Donnellan C, Hevey D, Hickey A, O’Neill D (2006) Defining and quantifying coping strategies after stroke: a review. J Neurol Neurosurg Psychiatry 77:1208–1218

    CAS  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Bornstein NM, Brainin M, Guekht A, Skoog I, Korczyn AD (2014) Diabetes and the brain: issues and unmet needs. Neurol Sci 35:995–1001

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Pendlebury ST, Rothwell PM (2009) Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol 8:1006–1018

    PubMed  Google Scholar 

  12. 12.

    Donnellan C, Al Banna M, Redha N, Al Jishi A, Al Sharoqi I, Taha S, Bakhiet M, Abdulla F, Walsh P (2016) Predictors of vascular cognitive impairment Poststroke in a Middle Eastern (Bahrain) Cohort: A Proposed Case-Control Comparison. JMIR Res Protoc 5:e223

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Chung C, Pollock A, Campbell T, Durward B, Hagen S (2013) Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult non-progressive acquired brain damage. Cochrane Database Syst Rev 30:4

    Google Scholar 

  14. 14.

    Vakhnina N, Nikitina L, Parfenov V, Yakhno N (2009) Post-stroke cognitive impairments. Neurosci Behavioral Physiol 39:719–724

    CAS  Google Scholar 

  15. 15.

    Kalaria RN, Ballard C (2001) Stroke and cognition. Curr Atheroscler Rep 3:334–339

    CAS  PubMed  Google Scholar 

  16. 16.

    Hu G-C, Chen Y-M (2017) Post-stroke dementia: epidemiology, mechanisms and management. Int J Gerontol 11:210–214

    Google Scholar 

  17. 17.

    Mijajlović MD, Pavlović A, Brainin M, Heiss W-D, Quinn TJ, Ihle-Hansen HB, Hermann DM, Assayag EB, Richard E, Thiel A, Kliper E, Shin Y-I, Kim Y-H, Choi S, Jung S, Lee Y-B, Sinanović O, Levine DA, Schlesinger I, Mead G, Milošević V, Leys D, Hagberg G, Ursin MH, Teuschl Y, Prokopenko S, Mozheyko E, Bezdenezhnykh A, Matz K, Aleksić V, Muresanu D, Korczyn AD, Bornstein NM (2017) Post-stroke dementia – a comprehensive review. BMC Med 15:11

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Sun J-H, Tan L, Yu J-T (2014) Post-stroke cognitive impairment: epidemiology, mechanisms and management. Ann Transl Med 2:80

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Xiong L, Reijmer YD, Charidimou A, Cordonnier C, Viswanathan A (2016) Intracerebral hemorrhage and cognitive impairment. Biochim Biophys Acta Mol basis Dis 1862:939–944

    CAS  Google Scholar 

  20. 20.

    Murao K, Rossi C, Cordonnier C (2013) Intracerebral haemorrhage and cognitive decline. Rev Neurol (Paris) 169:772–778

    CAS  Google Scholar 

  21. 21.

    Lei C, Lin S, Tao W, Hao Z, Liu M, Wu B (2013) Association between cerebral microbleeds and cognitive function: a systematic review. J Neurol Neurosurg Psychiatry 84:693–697

    PubMed  Google Scholar 

  22. 22.

    Viswanathan A, Greenberg SM (2011) Cerebral amyloid angiopathy in the elderly. Ann Neurol 70:871–880

    CAS  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Boyle PA, Yu L, Nag S, Leurgans S, Wilson RS, Bennett DA, Schneider JA (2015) Cerebral amyloid angiopathy and cognitive outcomes in community-based older persons. Neurol 85:1930–1936

    CAS  Google Scholar 

  24. 24.

    Smith EE, Beaudin AE (2018) New insights into cerebral small vessel disease and vascular cognitive impairment from MRI. Curr Opin Neurol 31:36–43

    PubMed  Google Scholar 

  25. 25.

    Planton M, Raposo N, Danet L, Albucher JF, Peran P, Pariente J (2017) Impact of spontaneous intracerebral hemorrhage on cognitive functioning: an update. Rev Neurol (Paris) 173:481–489

    CAS  Google Scholar 

  26. 26.

    Wood H (2015) Intracerebral haemorrhage: cognitive decline after intracerebral haemorrhage might be attributable to pre-existing factors. Nat Rev Neurol 11:546

    PubMed  Google Scholar 

  27. 27.

    Moher D, Liberati A, Tetzlaff J, Altman DG, The PG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097

    PubMed  PubMed Central  Google Scholar 

  28. 28.

    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349

    Google Scholar 

  29. 29.

    Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HCW (2010) The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res 19:539–549

    PubMed  PubMed Central  Google Scholar 

  30. 30.

    Xiong L, Davidsdottir S, Reijmer YD, Shoamanesh A, Roongpiboonsopit D, Thanprasertsuk S, Martinez-Ramirez S, Charidimou A, Ayres AM, Fotiadis P, Gurol E, Blacker DL, Greenberg SM, Viswanathan A (2016) Cognitive profile and its association with neuroimaging markers of non-demented cerebral amyloid angiopathy patients in a stroke unit. J Alzheimers Dis 52:171–178

    CAS  PubMed  Google Scholar 

  31. 31.

    Nakagawa K, King SL, Seto TB, Mau M (2018) Disparities in functional outcome after intracerebral hemorrhage among Asians and Pacific Islanders. Front Neurol 9:186

    PubMed  PubMed Central  Google Scholar 

  32. 32.

    Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J (1996) The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27:1304–1305

    CAS  PubMed  Google Scholar 

  33. 33.

    Knudsen KA, Rosand J, Karluk D, Greenberg SM (2001) Clinical diagnosis of cerebral amyloid angiopathy: Validation of the Boston Criteria. Neurology 56:537–539

    CAS  PubMed  Google Scholar 

  34. 34.

    Rost NS, Smith EE, Chang Y, Snider RW, Chanderraj R, Schwab K, FitzMaurice E, Wendell L, Goldstein JN, Greenberg SM, Rosand J (2008) Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke 39:2304–2309

    PubMed  Google Scholar 

  35. 35.

    Su CY, Chen HM, Kwan AL, Lin YH, Guo NW (2007) Neuropsychological impairment after hemorrhagic stroke in basal ganglia. Arch Clin Neuropsychol 22:465–474

    PubMed  Google Scholar 

  36. 36.

    Banerjee G, Wilson D, Ambler G, Osei-Bonsu Appiah K, Shakeshaft C, Lunawat S, Cohen H, Yousry TD, Lip GYH, Muir KW, Brown MM, Al-Shahi Salman R, Jager HR, Werring DJ (2018) Cognitive impairment before intracerebral hemorrhage is associated with cerebral amyloid angiopathy. Stroke 49:40–45

    PubMed  Google Scholar 

  37. 37.

    Flibotte JJ, Hagan N, O’Donnell J, Greenberg SM, Rosand J (2004) Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage. Neurology 63:1059–1064

    CAS  PubMed  Google Scholar 

  38. 38.

    Jamieson EI, Newman D, Metcalf AK, Naguib MF, Saada J, Potter JF, Myint PK (2012) Dementia is strongly associated with 90-day mortality in lobar cerebral amyloid angiopathy related intra-cerebral haemorrhage. J Neurol Sci 322:161–165

    PubMed  Google Scholar 

  39. 39.

    Planton M, Saint-Aubert L, Raposo N, Branchu L, Lyoubi A, Bonneville F, Albucher J-F, Olivot J-M, Péran P, Pariente J (2017) High prevalence of cognitive impairment after intracerebral hemorrhage. PLoS One 12:e0178886

    PubMed  PubMed Central  Google Scholar 

  40. 40.

    Benedictus MR, Hochart A, Rossi C, Boulouis G, Hénon H, van der Flier WM, Cordonnier C (2015) Prognostic factors for cognitive decline after Intracerebral hemorrhage. Stroke 46:2773–2778

    CAS  PubMed  Google Scholar 

  41. 41.

    Garcia PY, Roussel M, Bugnicourt JM, Lamy C, Canaple S, Peltier J, Loas G, Deramond H, Godefroy O (2013) Cognitive impairment and dementia after intracerebral hemorrhage: a cross-sectional study of a hospital-based series. J Stroke Cerebrovasc Dis 22:80–86

    PubMed  Google Scholar 

  42. 42.

    Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA (1987) MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol 149:351–356

    CAS  Google Scholar 

  43. 43.

    Laible M, Horstmann S, Mohlenbruch M, Schueler S, Rizos T, Veltkamp R (2017) Preexisting cognitive impairment in intracerebral hemorrhage. Acta Neurol Scand 135:628–634

    CAS  PubMed  Google Scholar 

  44. 44.

    Viswanathan A, Patel P, Rahman R, Nandigam RN, Kinnecom C, Bracoud L, Rosand J, Chabriat H, Greenberg SM, Smith EE (2008) Tissue microstructural changes are independently associated with cognitive impairment in cerebral amyloid angiopathy. Stroke 39:1988–1992

    PubMed  PubMed Central  Google Scholar 

  45. 45.

    Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, Lindley RI, O’Brien JT, Barkhof F, Benavente OR, Black SE, Brayne C, Breteler M, Chabriat H, DeCarli C, de Leeuw F-E, Doubal F, Duering M, Fox NC, Greenberg S, Hachinski V, Kilimann I, Mok V, Rv O, Pantoni L, Speck O, Stephan BCM, Teipel S, Viswanathan A, Werring D, Chen C, Smith C, van Buchem M, Norrving B, Gorelick PB, Dichgans M (2013) Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 12:822–838

    PubMed  PubMed Central  Google Scholar 

  46. 46.

    Banerjee G, Summers M, Chan E, Wilson D, Charidimou A, Cipolotti L, Werring DJ (2018) Domain-specific characterisation of early cognitive impairment following spontaneous intracerebral haemorrhage. J Neurol Sci 391:25–30

    PubMed  Google Scholar 

  47. 47.

    Cordonnier C, Leys D, Dumont F, Deramecourt V, Bordet R, Pasquier F, Hénon H (2010) What are the causes of pre-existing dementia in patients with intracerebral haemorrhages? Brain 133:3281–3289

    PubMed  Google Scholar 

  48. 48.

    Naidech AM, Beaumont JL, Rosenberg NF, Maas MB, Kosteva AR, Ault ML, Cella D, Ely EW (2013) Intracerebral hemorrhage and delirium symptoms. Length of stay, function, and quality of life in a 114-patient cohort. Am J Respir Crit Care Med 188:1331–1337

    PubMed  PubMed Central  Google Scholar 

  49. 49.

    Smith EE, Gurol ME, Eng JA, Engel CR, Nguyen TN, Rosand J, Greenberg SM (2004) White matter lesions, cognition, and recurrent hemorrhage in lobar intracerebral hemorrhage. Neurology 63:1606–1612

    CAS  PubMed  Google Scholar 

  50. 50.

    Jorm AF (1994) A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med 24:145–153

    CAS  PubMed  Google Scholar 

  51. 51.

    Tveiten A, Ljøstad U, Mygland Å, Naess H (2014) Functioning of long-term survivors of first-ever intracerebral hemorrhage. Acta Neurol Scand 129:269–275

    CAS  PubMed  Google Scholar 

  52. 52.

    Biffi A, Bailey D, Anderson CD, Ayres AM, Gurol EM, Greenberg SM, Rosand J, Viswanathan A (2016) Risk factors associated with early vs delayed dementia after intracerebral hemorrhage. JAMA Neurol 73:969–976

    PubMed  PubMed Central  Google Scholar 

  53. 53.

    Moulin S, Labreuche J, Bombois S, Rossi C, Boulouis G, Henon H, Duhamel A, Leys D, Cordonnier C (2016) Dementia risk after spontaneous intracerebral haemorrhage: a prospective cohort study. Lancet Neurol 15:820–829

    PubMed  Google Scholar 

  54. 54.

    Greenberg SM, Eng JA, Ning M, Smith EE, Rosand J (2004) Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage. Stroke 35:1415–1420

    PubMed  Google Scholar 

  55. 55.

    Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, Powers WJ, DeCarli C, Merino JG, Kalaria RN, Vinters HV, Holtzman DM, Rosenberg GA, Wallin A, Dichgans M, Marler JR, Leblanc GG (2006) National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 37:2220–2241

    PubMed  Google Scholar 

  56. 56.

    Román GC, Sachdev P, Royall DR, Bullock RA, Orgogozo J-M, López-Pousa S, Arizaga R, Wallin A (2004) Vascular cognitive disorder: a new diagnostic category updating vascular cognitive impairment and vascular dementia. J Neurol Sci 226:81–87

    PubMed  Google Scholar 

  57. 57.

    Sachdev P, Kalaria R, O’Brien J, Skoog I, Alladi S, Black SE, Blacker D, Blazer DG, Chen C, Chui H, Ganguli M, Jellinger K, Jeste DV, Pasquier F, Paulsen J, Prins N, Rockwood K, Roman G, Scheltens P (2014) Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord 28:206–218

    CAS  PubMed  PubMed Central  Google Scholar 

  58. 58.

    McGovern A, Pendlebury ST, Mishra NK, Fan Y, Quinn TJ (2016) Test accuracy of informant-based cognitive screening tests for diagnosis of dementia and multidomain cognitive impairment in stroke. Stroke 47:329–335

    PubMed  Google Scholar 

  59. 59.

    Sachdev PS, Lo JW, Crawford JD, Mellon L, Hickey A, Williams D, Bordet R, Mendyk A-M, Gelé P, Deplanque D, Bae H-J, Lim J-S, Brodtmann A, Werden E, Cumming T, Köhler S, Verhey FRJ, Dong Y-H, Tan HH, Chen C, Xin X, Kalaria RN, Allan LM, Akinyemi RO, Ogunniyi A, Klimkowicz-Mrowiec A, Dichgans M, Wollenweber FA, Zietemann V, Hoffmann M, Desmond DW, Linden T, Blomstrand C, Fagerberg B, Skoog I, Godefroy O, Barbay M, Roussel M, Lee B-C, Yu K-H, Wardlaw J, Makin SJ, Doubal FN, Chappell FM, Srikanth VK, Thrift AG, Donnan GA, Kandiah N, Chander RJ, Lin X, Cordonnier C, Moulin S, Rossi C, Sabayan B, Stott DJ, Jukema JW, Melkas S, Jokinen H, Erkinjuntti T, Mok VCT, Wong A, Lam BYK, Leys D, Hénon H, Bombois S, Lipnicki DM, Kochan NA (2017) STROKOG (stroke and cognition consortium): an international consortium to examine the epidemiology, diagnosis, and treatment of neurocognitive disorders in relation to cerebrovascular disease. Alzheimers Dement (Amst) 7:11–23

    Google Scholar 

  60. 60.

    Rodrigues JC, Becker N, Beckenkamp CL, Miná CS, de Salles JF, Bandeira DR (2019) Psychometric properties of cognitive screening for patients with cerebrovascular diseases a systematic review. Dement Neuropsychol 13:31–43

    PubMed  PubMed Central  Google Scholar 

  61. 61.

    Pinho J, Costa AS, Araujo JM, Amorim JM, Ferreira C (2019) Intracerebral hemorrhage outcome: a comprehensive update. J Neurol Sci 398:54–66

    PubMed  Google Scholar 

  62. 62.

    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Arlington

    Google Scholar 

  63. 63.

    Al Banna M, Redha NA, Abdulla F, Nair B, Donnellan C (2016) Metacognitive function poststroke: a review of definition and assessment. J Neurol Neurosurg Psychiatry 87:161–166

    PubMed  Google Scholar 

  64. 64.

    Hayes S, Donnellan C, Stokes E (2013) Associations between executive function and physical function poststroke: a pilot study. Physiotherapy 99:165–171

    PubMed  Google Scholar 

  65. 65.

    Hayes S, Donnellan C, Stokes E (2015) Executive dysfunction post-stroke: an insight into the perspectives of physiotherapists. Disabil Rehabil 37:1817–1824

    PubMed  Google Scholar 

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The authors would like to thank Ms. Kate Brunskill, Deputy Librarian, Queen Square Library, Institute of Neurology and the National Hospital for Neurology and Neurosurgery for advising on the review search strategy and criteria.

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Correspondence to Claire Donnellan.

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Donnellan, C., Werring, D. Cognitive impairment before and after intracerebral haemorrhage: a systematic review. Neurol Sci 41, 509–527 (2020).

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  • Intracerebral haemorrhage
  • Cognitive impairment
  • Dementia
  • Neuropsychological assessment
  • Stroke