Résumés disponibles (85) :

MOULIN Solene (INSERM U1171 - Charlotte CORDONNIER)
Session :

 

@mail :  solene.moulin2@chru-lille.fr      tél. :  0320446814


Mots-clés : 

Titre de la communication :
New-onset dementia after spontaneous intracerebral haemorrhage: a prospective observational cohort study.
Auteurs (et leurs adresses) de la communication :
S. Moulin (1), J. Labreuche (2), S. Bombois (1), C. Rossi (1), H. Hénon (1), A. Duhamel (2), D. Leys (1), C. Cordonnier (1) (1) Service de neurologie, C.H.U Lille, INSERM U1171, Lille (2) Département de biostatistiques, C.H.U Lille, EA 2694, Lille
Résumé de la communication :
Background:
Dementia is an important public health issue, and the contribution of stroke to dementia is large at the community level worldwide. Dementia occurs in at least 10% of patients within one year after stroke. However, no prospective study has focused on the risk of dementia after spontaneous intracerebral haemorrhage (ICH) that accounts for 15% of all strokes. We aimed to determine the incidence and prognostic factors of dementia after an ICH. We hypothesized that patients with lobar ICH - without dementia before - were at higher risk of developing new-onset dementia because of a strong influence of underlying cerebral amyloid angiopathy (CAA).
Methods:
We did a prospective observational cohort study (median follow-up: 6 years) of patients with spontaneous ICH who were admitted at the Lille University Hospital, France. We studied prognostic factors [clinical and neuroradiological (MRI) biomarkers] of new-onset dementia with a pre-specified subgroup analysis according to ICH location. We performed multivariable analyses using competing risk analyses (competing event: death).
Findings:
Between November 2004 and April 2009, we enrolled 560 consecutive patients with spontaneous ICH of whom 218 patients (median age 67·5 years) without pre-existing dementia were alive at six months and included in the study. Sixty-three patients developed new-onset dementia leading to an incidence rate of 14·2% (95%CI 10·0-19·3) at 1 year after ICH onset that reached 28·3% (95%CI 22·4-34·5) at 4 years. Patients with lobar ICH had an incidence of new-onset dementia twice higher than patients with non lobar ICH (incidence at one year respectively: 23·4%; 95%CI 14·6-33·3 versus 9·2%; 95%CI 5·1-14·7). Disseminated superficial siderosis [SubHazard Ratio (SHR) 7·45; 95%CI4·27-12·99], cortical atrophy score (SHR per 1-point increase 2·61; 95%CI 1·70-4·01), a higher number of cerebral microbleeds (SHR for >5 CMBs 2·33; 95%CI 1·38-3·94) and older age (SHR per 10-year increase 1·34; 95%CI1·00-1·79) were prognostic factors of new-onset dementia.
Interpretation:
There is a substantial risk of incident dementia among non-demented survivors of spontaneous ICH. Our results suggest a strong implication of underlying CAA. Future clinical trials dedicated to ICH should include cognitive endpoints.

MOULIN Solene (INSERM U1171 - Charlotte CORDONNIER)