The objective of this study was to identify preadmission and admission factors associated with cognition after hemorrhagic stroke.

Hemorrhagic stroke survivors may have cognitive limitations. Understanding associated factors can guide surveillance and interventions. 

Patients with non-traumatic intracerebral or subarachnoid hemorrhage (ICH or SAH) admitted at an urban academic medical center between January 2015 and January 2024 were assessed by telephone 3 months post-discharge using the Quality of Life in Neurological Disorders (Neuro-QoL) Cognitive Function short form. Univariate and multivariate analysis were used to evaluate the relationship between poor cognition (Neuro-QoL t-score ≤50) and preadmission and admission factors in patients with 1) ICH or SAH and 2) ICH only.   

Of 101 patients [62 ICH and 39 SAH; median age 61 (IQR 46-69), 56 (55.4%) with private insurance, 24 (23.8%) with BMI > 30], 51 (50%) had poor cognition 3-months post-bleed. On univariate analysis of both the full cohort and ICH only cohort, poor cognition was associated with (p<0.05): age; insurance type; BMI; and admission mRS, NIHSS, and APACHE II scores. On multivariate analysis of the full cohort, poor cognition was associated with mRS > 0 [OR 4.97 (1.30-19.0), p = 0.019], NIHSS score [OR 1.14 (1.02-1.28), p = 0.026], private insurance [OR 0.21 (0.06-0.76), p = 0.017] and BMI>30 [OR 0.13 (0.03-0.56), p = 0.006]. On multivariate analysis of patients with ICH only, poor cognition was associated with APACHE II score [OR 1.33 (1.07-1.66), p = 0.01], private insurance [OR 0.08 (0.008-0.81), p = 0.033] and BMI>30 [OR 0.03 (0.004-0.28), p = 0.002].

Cognitive limitations after hemorrhagic stroke are less common in patients with private insurance and BMI>30. Heightened surveillance for non-obese patients without private insurance is suggested. Additional investigation into the relationship between cognition and insurance type and BMI is needed.