Cerebral Microbleeds and Long-Term Affective Symptoms in Survivors of Spontaneous Intracerebral Hemorrhage.
Journal
Journal of the American Heart Association
Journal Volume
15
Journal Issue
2
Start Page
Article Number e044666
ISSN
2047-9980
Date Issued
2026-01-20
Author(s)
Lin, Sheng-Sian
Chiang, Pu-Tien
Hsieh, Pei-Feng
Tsai, Li-Kai
Tsai, Hsin-Hsi
Jeng, Jiann-Shing
Abstract
BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) is strongly associated with the development of long-term cognitive impairment and neuropsychiatric symptoms (NPS), particularly affective disturbances including depression and anxiety. Although small vessel disease (SVD) underlies most cases of ICH, the contribution of SVD to persistent affective symptoms and the effects of cognitive dysfunction on NPS remain unclear. METHODS: We prospectively recruited 95 survivors of spontaneous ICH (median, 5.7 years post-ICH) between 2021 and 2025 from stroke clinics using standardized clinical protocols. NPS were assessed using the Neuropsychiatric Inventory Questionnaire. Cognitive status was evaluated; brain magnetic resonance imaging was performed to quantify SVD markers. Logistic regression and mediation analyses were used to examine the associations between SVD burden, affective symptoms, and cognition. RESULTS: Affective symptoms were the most prevalent NPS subsyndrome (37.9%), followed by apathy/vegetative symptoms (32.6%). Patients with affective symptoms showed greater cognitive impairment and higher hypertensive SVD burden, including higher numbers of deep cerebral microbleeds (4.0±5.9 versus 1.2±1.9, P=0.010) and lacunes (47.2% versus 23.7%, P=0.024) than those without affective symptoms. In the multivariable model, deep cerebral microbleeds (adjusted odds ratio, 1.215 [95% CI, 1.03–1.43], P=0.021), but not lacunes, were independently associated with affective symptoms. Mediation analysis revealed that cognitive impairment partially mediated this relationship (indirect effect P=0.012; 35.9% of total effect). CONCLUSIONS: Affective symptoms are common long-term outcomes after ICH; deep perforator arteriopathy, especially with the form of deep cerebral microbleeds, contribute to these symptoms; cognitive dysfunction only partly mediates this association. There is a need to screen NPS and evaluate microvascular pathology to assess emotional health post ICH.
Subjects
cerebral microbleed
cognitive impairment
depression
intracerebral hemorrhage
neuropsychiatric symptoms
Publisher
American Heart Association Inc.
Type
journal article