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January 16, 2026Journal of the American Heart Association0 citationsOpen Access

Cerebral Microbleeds and Long‐Term Affective Symptoms in Survivors of Spontaneous Intracerebral Hemorrhage

SLSheng‐Sian LinNational Taiwan University Hospital PCPu‐Tien ChiangNational Taiwan University PHPei‐Feng HsiehNational Taiwan University Hospital

Key Points

The study aims to explore the relationship between cerebral microbleeds and long-term affective symptoms in survivors of spontaneous intracerebral hemorrhage.
Prospective recruitment of 95 spontaneous ICH survivors from stroke clinics.
Assessment of neuropsychiatric symptoms using the Neuropsychiatric Inventory Questionnaire.
Evaluation of cognitive status and brain MRI to quantify small vessel disease markers.
Usage of logistic regression and mediation analyses to analyze associations.
Affective symptoms were present in 37.9% of survivors, the most common neuropsychiatric symptom.
Affected patients exhibited significantly higher cognitive impairment and small vessel disease burden.
Higher counts of deep cerebral microbleeds (mean 4.0) in those with affective symptoms compared to non-affected (mean 1.2, P =0.010).
Logistic regression identified deep cerebral microbleeds as independently associated with affective symptoms (adjusted odds ratio 1.215, P =0.021).
Cognitive impairment partially mediated the relationship between SVD and affective symptoms.

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.

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