The Long Term (Five Year) Neuropsychological and Functional Outcomes of Primary Intracerebral Haemorrhage. A Population Based Study.

Abstract

This study examined the long-term (5-year) neuropsychological and functional outcomes of primary intracerebral haemorrhage (ICH) using a population-based sample. The World Health Organisation‟s model of health outcomes; the International Classification of Functioning (ICF), was used to identify areas for consideration in characterising outcomes. The specific aims of the study were to explore outcomes, in a comparison with matched healthy controls, in ICH survivors in neurological and neuropsychological functioning, mood, ADLs and HRQoL. In addition, the study sought to explore: whether there is evidence of recovery in mood, ADLs, and HRQoL in the ICH group over time; whether there are relationships between the different outcomes and, whether demographic variables such as age, gender and education play a role in outcomes from an ICH. In a population-based incidence study of stroke undertaken in Auckland, New Zealand (Auckland Regional Community Stroke Study [ARCOS]), 19 participants were recruited of whom 77 had experienced a primary ICH during a period of one year, from March 1st 2002 to February 28th 2003. This represented 25% of the original population sample from ARCOS and 42% of those alive, contactable and able to take part at a five year follow up. A healthy control group was also recruited, and was matched to the ICH group on age, gender, ethnicity, and education. Both the ICH and control group were examined on a series of measures considering neurological and neuropsychological functioning, mood, activities of daily living (ADLs), and health related quality of life (HRQoL). As there was also available data from the ARCOS study in regard to outcomes relating to function, mood and HRQoL, this data was also used to examine the change in outcomes over a period of five years. The results indicate that ICH survivors continued to experience impairment in neurological and neuropsychological functioning, performing significantly worse in comparison with the matched control group at five years post-ICH. They were also likely to experience significantly more symptoms of depression. In addition, they were more likely to experience limitations in ADLs. However, the ICH survivors enjoyed a relatively similar HRQoL to that of the matched controls, differing significantly only in the areas where physical functioning had a role. There were relationships between outcomes; poorer neurological functioning was significantly correlated with deficits in information processing speed and greater overall cognitive impairment. In addition, deficits in information processing speed and executive functioning were associated with reduced HRQoL, and those with depressed mood were more likely to have difficulties in ALDs and a poorer HRQoL in some areas of their lives. There were no differences in performance on any of the measures associated with age or gender. However, education was associated with better overall cognitive function. When considering performance on measures over time there was generally an improvement in the level of engagement with ADLs, however there was no change in HRQoL. To summarise, at five years post ICH survivors experience significantly poorer neurological neuropsychological, mood and functional than the matched controls. However, their quality of life is similar to that of the matched controls except in the aspects of living where their physical functioning plays a role.