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Prevalence of Concomitant Neurological Disorders and Long-Term Outcome of Patients Hospitalized for Intracerebral Hemorrhage with Versus without Cerebral Amyloid Angiopathy

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Abstract

Background

Patients with intracerebral hemorrhage (ICH) related to cerebral amyloid angiopathy (CAA) are at increased risk of developing epilepsy and cognitive disorders such as Alzheimer’s disease (AD), mild cognitive impairment (MCI), and vascular dementia. In a retrospective cohort observation study of patients hospitalized for ICH with CAA versus ICH without CAA, we evaluated the prevalence of neurological comorbidities at admission and the risk of new diagnosis of epilepsy, relevant cognitive disorders, and mortality at 1 year.

Methods

In the TriNetX health research network, adult patients aged ≥ 55 years hospitalized with a diagnosis of ICH were stratified based on presence or absence of concomitant CAA diagnosis. Demographics and medical comorbidities were compared by using χ2 test and Student’s t-test. After 1:1 propensity score matching, 1-year survival was assessed with Kaplan–Meier curves. The 1-year risk of new diagnosis of epilepsy, AD, MCI, vascular dementia, and dementia unspecified was assessed with Cox proportional hazards estimate.

Results

The study included a total of 1757 patients with ICH and CAA and 53,364 patients with ICH without CAA. Patients with CAA were older compared with those without CAA (74.1 ± 7.5 vs. 69.8 ± 8.8 years, p ≤ 0.001). Compared with ICH without CAA, patients with ICH and CAA had higher baseline prevalence of cerebral infarction (30% vs. 20%), nontraumatic ICH (36% vs. 7%), nontraumatic subarachnoid hemorrhage (14% vs. 5%), epilepsy (11% vs. 6%), and AD (5% vs. 2%) with significance at p < 0.001. After propensity score matching, a total of 1746 patients were included in both cohorts. In the matched cohorts, compared with patients with ICH without CAA, patients with ICH and CAA had lower 1-year all-cause mortality (479 [27%] vs. 563 [32%]; hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.71–0.90) and higher risk of new diagnosis of epilepsy (280 [18%] vs. 167 [11%]; HR 1.70; 95% CI 1.40–2.06), AD (101 [6%] vs. 38 [2%]; HR 2.62; 95% CI 1.80–3.80), MCI (85 [5%] vs. 35 [2%]; HR 2.39; 95% CI 1.61–3.54), vascular dementia (117 [7%] vs. 60 [4%]; HR 1.92; 95% CI 1.41–2.62), and dementia unspecified (245 [16%] vs. 150 [9%]; HR 1.70; 95% CI 1.39–2.08).

Conclusions

Among patients admitted for ICH, patients with CAA have lower mortality but have 2–3 times more risk of diagnosis of epilepsy and dementia at 1 year, compared with those without CAA.

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Authors and Affiliations

  1. Department of Neurology, Milton S. Hershey Medical Center, Penn State College of Medicine, 30 Hope Drive EC037, Hershey, PA, 17033, USA

    Nandakumar Nagaraja & Varalakshmi Ballur Narayana Reddy

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  1. Nandakumar Nagaraja
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  2. Varalakshmi Ballur Narayana Reddy
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Contributions

NN: Conception and study design, data analysis and interpretation, drafting and revising the article, final approval of version to be published. V Ballur Narayana Reddy: Conception and study design, interpretation of data, drafting and revising the article for important intellectual content, final approval of version to be published.

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Correspondence to Nandakumar Nagaraja.

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Authors confirm adherence to ethical guidelines. Institutional review board approval was not required for this study. The study was performed using TriNetX database that uses deidentified aggregate patient data for analysis. No protected health information or personal data are made available to the users of the platform.

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Nagaraja, N., Ballur Narayana Reddy, V. Prevalence of Concomitant Neurological Disorders and Long-Term Outcome of Patients Hospitalized for Intracerebral Hemorrhage with Versus without Cerebral Amyloid Angiopathy. Neurocrit Care 40, 486–494 (2024). https://doi.org/10.1007/s12028-023-01753-x

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