Even if patients survive an intracerebral hemorrhage (ICH), they may be at an increased risk of future mental issues. A recent longitudinal study found that 40 percent of ICH survivors had depression within five years. The researchers also noted that patients diagnosed with depression often later had dementia.
The results were presented at the American Stroke Association’s International Stroke Conference in Houston on Feb. 22.
The findings confirm other trials that have had similar conclusions. Previous studies found that at five years, 20 percent to 40 percent of ICH survivors had new-onset depression and 30 percent to 45 percent of ICH survivors had cognitive decline or dementia.
The 695 ICH survivors in the study completed phone surveys every six months and provided information on their mood, anxiety and cognitive performance. The patients all had no history of depression in the five years prior to stroke. Approximately half of the patients were women, 75 percent were white and most had hypertension, diabetes or hyperlipidemia.
During a median follow-up period of 49.6 months, 40 percent of the ICH survivors developed new-onset depression, which translates to a 7.1 percent estimated annual post-ICH depression incidence.
The researchers also found that 80 percent of patients diagnosed with depression also had dementia. In 81 percent of those cases, depression preceded post-ICH dementia.
Further, they noted that risk factors typically associated with the risk of a recurrent hemorrhagic stroke also predicted the risk of developing depression. Those risk factors included lower educational levels, evidence of disease of the white matter of the brain and carrying a variant of the apoliprotein E gene.
Still, the study had a few limitations, according to the researchers. Most notably, they could not infer any causal relationships because of the study’s design. They also did not capture the severity of mood symptoms or apathy symptoms. In addition, fewer than 20 percent of ICH survivors were minorities, so the results might not be generalizable to all patient groups.
“Our study changes the way we look at depression after a hemorrhagic stroke,” lead researcher Alessandro Biffi, MD, of Massachusetts General Hospital in Boston, said in a news release. “Depression is not just an isolated phenomenon following a hemorrhagic stroke. It may identify those who are likely to develop dementia, and this is important when these patients are evaluated, particularly in outpatient care settings.”