Prediction of cognitive impairment in acute spontaneous intracerebral hemorrhage: The role of proper control of hypertension

Objective: Hypertension is the commonest cause of acute spontaneous intracerebral hemorrhage ICH which is life-threatening with a poor prognosis. The study aims to evaluate the cognitive impairment in patients presented by ICH. Methods: The patients were assessed at the onset by clinical, radiological, and severity scores (National Institutes of Health Stroke Scale NIHSS, Glasgow Coma Scale score GCS, modified Rankin Scale mRS). After 3 months they were classified according to the Montreal Cognitive Assessment MoCA score into preserved cognition >= 26 and impaired cognition <26. Independent factors that were significantly related to cognitive decline were assessed by multivariate logistic regression. Correlation of the cognitive impairment in ICH and NIHSS, GCS, mRS, and control of blood pressure BP was calculated by Spearman's correlation. Results: Systolic BP at the onset of ICH, 6, 24 hours after admission was higher in patients with impaired cognition (P=0.01, 0.009, and 0.01 respectively). The independent variables related to cognitive impairment were older age and female gender (P=0.02, 0.04 respectively), and lower systolic blood pressure six hours after admission to hospital (P=0.006), increased mRS (P=0.003), the larger volume of hematoma (P=0.04), infratentorial ICH (P=0.02), and presence of hydrocephalic changes (P=0.004). Conclusion: Proper control and monitoring of the blood pressure in patients with acute ICH must be initiated immediately especially in the first six hours after hospitalization.