Post-Intracerebral Hemorrhage, Depression and Dementia Risks Increased
Patients at greater risk of depression had lower education levels, were APOE ε4 carriers, and had moderate to severe white matter disease.
Depression after intracerebral hemorrhage (ICH) is associated with an increased risk for dementia in patients with shared risk factors, according to findings presented at the 2017 International Stroke Conference, February 22-24, 2017, in Houston, Texas.
While both post-ICH depression and cognitive decline are common, there is a lack of long-term data to illustrate any kind of clinical overlap between the 2 conditions. In the current study, Alessandro Biffi, MD, of Massachusetts General Hospital in Boston, and colleagues followed 695 survivors (50% women) of ICH with no prior history of depression for 5 years. Follow-up data on mood, anxiety, and cognitive health were collected via phone interviews every 6 months.
Nearly 50 months into follow-up, 40% of the participants developed a mood disorder, resulting in an incidence rate for post-ICH depression of nearly 7% per year (95% CI, 5.5-5.8). Participants at greater risk of depression had a lower education level, were APOE ε4 carriers, and had moderate to severe white matter disease confirmed by computed tomography scan (P <.05) – all of which, the investigators pointed out, are also risk factors for ICH recurrence.
Ultimately, 63% of participants were diagnosed with both depression and dementia, with depression preceding dementia onset within a median of 17.5 months in 80% of cases (95% CI, 71-88; P =.002).
“When caring for hemorrhagic stroke patients, healthcare providers tend to focus on preventing another stroke,” Dr Biffi said in a statement. “We have found that even among patients who do not have a second stroke, the incidence of depression and subsequently dementia is very high, and healthcare providers need to be on the lookout for it in order to counsel patients and families.”
- Biffi A, Kourkoulis C, Schwab K, et al. Newly-diagnosed depression precedes cognitive impairment following intracerebral hemorrhage. Presented at: International Stroke Conference. February 22-24, 2017; Houston, TX. Abstract 93.
- Bleeding stroke survivors at higher risk of depression, dementia [news release]. Houston, TX: American Stroke Association newsroom; February 22, 2017. http://newsroom.heart.org/news/bleeding-stroke-survivors-at-higher-risk-of-depression-dementia?preview=a5c5. Accessed February 22, 2017.