ICH Survivors at High Risk for Depression, Then Dementia

Megan Brooks

February 23, 2017

HOUSTON, Texas — A large number of patients who survive intracerebral hemorrhage (ICH) will develop depression, which is often followed by the onset of dementia, a new study suggests.

"Our study changes the way we look at depression after a hemorrhagic stroke," lead researcher, Alessandro Biffi, MD, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, said in a statement.

"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," added Dr Biffi.

Dr Alessandro Biffi

He presented the study here at the International Stroke Conference (ISC) 2017.

Until now, there have been limited long-term data on the degree to which post-ICH depression and dementia overlap, Dr Biffi explained during a news briefing.

To investigate, the researchers followed 695 survivors of ICH (50% women, 75% white) with no history of depression for 5 years. Most of the patients had at least one cardiovascular and cerebrovascular risk factor, such as hypertension, diabetes, or hyperlipidemia. They collected data on mood, anxiety, and cognitive performance every 6 months.

"Perhaps the most interesting result," said Dr Biffi, is that new-onset depression after ICH is "very common." During a median follow-up of nearly 50 months, 278 of the 695 ICH survivors (40%) developed new-onset depression, a rate of about 7% per year (95% confidence interval [CI], 4.8 - 9.6%). This is higher than that reported in the general population of the same age and sex, said Dr Biffi.

Independent risk factors for post-ICH depression included lower educational levels, evidence of moderate to severe cerebral small vessel disease on imaging, and presence of the APOE ε4 variant.

The data also suggest that depression "continues to accumulate after stroke; it's not only directly related to the immediate hemorrhage in the brain, but it actually continues to accumulate over time," he noted.

"The other interesting finding from our study is that depression and dementia tend to coexist very frequently," reported Dr Biffi. Depression and dementia were codiagnosed in 220 of 278 patients (80%). Depression preceded post-ICH dementia in 81% of cases. The median time between depression diagnosis and dementia diagnosis was 17.6 months on average (interquartile range, 12.6 - 23.2; P < .001).

"This is relevant because if this is indeed a reproducible, generalizable phenomenon, the onset of new diagnosis of depression in our intracerebral hemorrhage survivors is of great relevance when providing clinical care, particularly long term," said Dr Biffi.

Unique Study Helps Fill Gap

"This is a very interesting study from my perspective because there's not a lot of information about depression and dementia after intracranial hemorrhage," said Philip B. Gorelick, MD, professor at Michigan State University College of Human Medicine, Grand Rapids, and medical director of the Mercy Health Hauenstein Neuroscience Center.

Dr Philip B. Gorelick

"Some of the prior studies have been a shorter duration, so they might go up to 90 days, or maybe a year, or a little bit more. This study is very unique in that it goes out to about 50 months, so we're covering a little more than 4 years of time," added Dr Gorelick, a spokesperson for the American Stroke Association.

ICH can have up to a 50% mortality rate, "and there has been limited information about what actually happens to [survivors] in the long term, and this study by Biffi and colleagues from the Massachusetts General Hospital fills in a lot of gaps for us," he added.

The study was funded by the National Institute of Neurological Disorders and Stroke. Dr Biffi has disclosed no relevant financial relationships.

International Stroke Conference (ISC) 2017. Abstract 93. Presented February 22, 2017.

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