Abstract Body: Background and objective. Cerebral amyloid angiopathy (CAA) is one of the major causes of intracranial hemorrhage (ICH) and consequent functional impairments in the elderly. Currently, there is a lack of predictors of functional prognosis for CAA patients suffering after lobar ICH event. This study aimed to assess the clinical and neuroimaging factors that can predict functional outcomes in patients survived CAA-related ICH.
Methods. Conducted as a retrospective cohort study from May 2014 to May 2022, this research included ICH survivors meeting the Boston criteria 2.0 of probable CAA. Rehabilitation metrics and neuroimaging features from MRI, including lobar cerebral microbleeds (CMBs), cortical superficial siderosis (cSS), perivascular spaces of the centrum-semiovale, and white matter hyperintensities (WMHs), were systematically assessed and subjected to analysis. CAA score was computed as a sum of these markers. Prognostic indicators, comprising the modified Rankin Scale (mRS) and Barthel Index at one month after ICH were evaluated. The data were analyzed with generalized linear models and logistic regression to examine the associations between the identified parameters and the prognostic indicators. The incidences of recurrent ICH or mortality within a six-month follow-up window were also assessed using survival analyses.
Results. A total of 73 patients were included. In the multivariate analysis, predictive factors for higher mRS included impaired initial sitting balance (p<0.001), compromised initial ability to sit up (p<0.001), and higher CAA score (p=0.01) after adjusting covariants for age, sex, antithrombotic use, and pre-morbid mRS. During 6-month follow-up after ICH, a lower CAA score was associated with lower ICH recurrence (p < 0.05), while better sitting balance was associated with lower mortality rate (p < 0.05).
Conclusion. In patients with CAA-related ICH, compromised sitting ability and higher CAA score predicted unfavorable functional outcomes.