Abstract Body: Background: Intracerebral hemorrhage (ICH) is a severe stroke type with high mortality, significantly affecting survivors' quality of life (QOL) through functional, cognitive, and psychosocial impairments.

Objective: To investigate longitudinal trajectories of functional, neurological, cognitive, and QOL outcomes following ICH, utilizing data from the Brain Attack Surveillance in Corpus Christi (BASIC) project (2014-2019).

Methods: Baseline demographic and clinical characteristics were collected. Neurological, functional, cognitive, and QOL outcomes were measured using the National Institutes of Health Stroke Scale (NIHSS), Activities of Daily Living (ADL/IADL), Modified Mini-Mental State Exam (3-MSE), and Stroke-Specific QOL (SS-QOL) scale at 3-, 6-, and 12-months post-stroke. Linear regression models with generalized estimating equations assessed changes over time, adjusting for covariates including age, sex, race/ethnicity, education, pre-stroke status, and comorbidities. Inverse probability weighting and multiple imputation were applied.

Results: Analysis included 328 first-ever ICH patients, with 117 completing at least one follow-up. Baseline demographics: 63.1% Mexican American, 55.5% male, mean age 68.9 years. One-year mortality was 43.3%. Among the 117, functional outcomes improved significantly: from 2.48 (SD=1.00) at 3 months to 2.14 (SD=0.93) at 12 months (adjusted difference: -0.33; 95% CI: -0.49 to -0.18; p<0.001). NIHSS scores reduced from 3.45 (SD=4.38) to 2.6 (SD=5.14) (adjusted change: -20%; 95% CI: -30% to -9%; p<0.001). Cognitive scores increased from 79.2 (SD=15.2) to 82.3 (SD=13.0) (adjusted difference: 5.13; 95% CI: 1.56 to 8.71; p=0.005). QOL improved from 3.16 (SD=1.09) to 3.45 (SD=1.01) (adjusted difference: 0.30; 95% CI: 0.16 to 0.44; p<0.001).

Conclusion: Despite a high mortality rate of ICH, survivors demonstrated significant improvements in all outcomes over the first year. For most outcomes, the most notable gains occurred in the initial 3 to 6 months, though functional outcomes and quality of life showed continued improvement from 6 to 12 months. These findings emphasize the potential for recovery and the importance of early and intensive rehabilitation efforts to optimize long-term outcomes for ICH patients.