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Cognitive Impairment After Intracerebral Hemorrhage: A Systematic Review of Current Evidence and Knowledge Gaps.
Frontiers in Neurology ( IF 3.4 ) Pub Date : 2021-08-27 , DOI: 10.3389/fneur.2021.716632
Thomas Potter 1 , Vasileios-Arsenios Lioutas 2 , Mauricio Tano 1, 3 , Alan Pan 1 , Jennifer Meeks 1 , Daniel Woo 4 , Sudha Seshadri 5 , Magdy Selim 2 , Farhaan Vahidy 1, 6
Affiliation  

Background: Cognitive impairment (CI) is commonly observed after intracerebral hemorrhage (ICH). While a growing number of studies have explored this association, several evidence gaps persist. This review seeks to investigate the relationship between CI and ICH. Methods: A two-stage systematic review of research articles, clinical trials, and case series was performed. Initial search used the keywords ["Intracerebral hemorrhage" OR "ICH"] AND ["Cognitive Impairment" OR "Dementia OR "Cognitive Decline"] within the PubMed (last accessed November 3rd, 2020) and ScienceDirect (last accessed October 27th, 2020) databases, without publication date limits. Articles that addressed CI and spontaneous ICH were accepted if CI was assessed after ICH. Articles were rejected if they did not independently address an adult human population or spontaneous ICH, didn't link CI to ICH, were an unrelated document type, or were not written in English. A secondary snowball literature search was performed using reviews identified by the initial search. The Agency for Healthcare research and Quality's assessment tool was used to evaluate bias within studies. Rates of CI and contributory factors were investigated. Results: Search yielded 32 articles that collectively included 22,631 patients. Present evidence indicates a high rate of post-ICH CI (65-84%) in the acute phase (<4 weeks) which is relatively lower at 3 (17.3-40.2%) and 6 months (19-63.3%). Longer term follow-up (≥1 year) demonstrates a gradual increase in CI. Advanced age, female sex, and prior stroke were associated with higher rates of CI. Associations between post-ICH CI and cerebral microbleeds, superficial siderosis, and ICH volume also exist. Pre-ICH cognitive assessment was missing in 28% of included studies. The Mini Mental State Evaluation (44%) and Montreal Cognitive Assessment (16%) were the most common cognitive assessments, albeit with variable thresholds and definitions. Studies rarely (<10%) addressed racial and ethnic disparities. Discussion: Current findings suggest a dynamic course of post-ICH cognitive impairment that may depend on genetic, sociodemographic and clinical factors. Methodological heterogeneity prevented meta-analysis, limiting results. There is a need for the methodologies and time points of post-ICH cognitive assessments to be harmonized across diverse clinical and demographic populations.

中文翻译:

脑出血后的认知障碍:对当前证据和知识差距的系统评价。

背景:认知障碍 (CI) 常见于脑出血 (ICH) 后。虽然越来越多的研究探索了这种关联,但仍然存在一些证据空白。本综述旨在调查 CI 和 ICH 之间的关系。方法:对研究文章、临床试验和病例系列进行了两阶段系统评价。初始搜索使用了 PubMed(上次访问时间为 2020 年 11 月 3 日)和 ScienceDirect(上次访问时间为 2020 年 10 月 27 日)中的关键字[“脑出血”或“ICH”] AND [“认知障碍”或“痴呆症或认知衰退”] ) 数据库,没有发表日期限制。如果在 ICH 之后评估 CI,则接受涉及 CI 和自发性 ICH 的文章。如果文章没有独立地针对成年人群或自发性 ICH,没有将 CI 与 ICH 联系起来,是不相关的文件类型,或者不是用英文写的,则被拒绝。使用初始搜索确定的评论进行了二次滚雪球文献搜索。医疗保健研究和质量机构的评估工具用于评估研究中的偏倚。调查了 CI 的比率和促成因素。结果:搜索产生了 32 篇文章,总共包括 22,631 名患者。目前的证据表明,急性期(<4 周)的 ICH 后 CI 发生率很高(65-84%),在 3 个月(17.3-40.2%)和 6 个月(19-63.3%)时相对较低。长期随访(≥1 年)表明 CI 逐渐增加。高龄,女性,和既往卒中与较高的 CI 率相关。ICH 后 CI 与脑微出血、浅表铁沉积和 ICH 体积之间也存在关联。28% 的纳入研究缺少 ICH 前认知评估。迷你精神状态评估 (44%) 和蒙特利尔认知评估 (16%) 是最常见的认知评估,尽管阈值和定义各不相同。研究很少(<10%)涉及种族和民族差异。讨论:目前的研究结果表明,ICH 后认知障碍的动态过程可能取决于遗传、社会人口统计学和临床​​因素。方法异质性阻碍了荟萃分析,限制了结果。需要在不同的临床和人口统计人群中协调 ICH 后认知评估的方法和时间点。
更新日期:2021-08-27
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