Agitation, Delirium, and Cognitive Outcomes in Intracerebral Hemorrhage

Background: Delirium predicts higher long-term cognitive morbidity. We previously identified a cohort of patients with spontaneous intracerebral hemorrhage and delirium and found worse outcomes in health related quality of life (HRQoL) in the domain of cognitive function. Objective: We tested the hypothesis that agitation would have additional prognostic signcance on later cognitive function HRQoL. Methods: Prospective identification of 174 patients with acute intracerebral hemorrhage, measuring stroke severity, agitation, and delirium, with a standardized protocol and measures. HRQoL was assessed using the Neuro-QOL at 28 days, 3 months, and 1 year. Functional outcomes were measured with the modified Rankin Scale. Results: Among the 81 patients with HRQoL follow-up data available, patients who had agitation and delirium had worse cognitive function HRQoL scores at 28 days(T scores for delirium with agitation 20.9 +/- 7.3, delirium without agitation 30.4 +/- 16.5, agitation without delirium 36.6 +/- 17.5, and neither agitated nor delirious 40.3 +/- 15.9; p = 0.03) and at 1 year (p = 0.006). The effect persisted in mixed models after correction for severity of neurologic injury, age, and time of assessment (p = 0.0006) and was not associated with medication use, seizures, or infection. Conclusions: The presence of agitation with delirium in patients with intracerebral hemorrhage may predict higher risk of unfavorable cognitive outcomes up to 1 year later.