Impact of rehabilitation trajectory on affective and cognitive impairment after intracerebral hemorrhage: a cohort study

Background Spontaneous intracerebral hemorrhage (ICH) significantly affects cognitive and affective functions, with most studies focusing on factors present at or before the index event. This study examines the impact of rehabilitation trajectories within 12 months on cognitive impairment, depression, and anxiety in supratentorial ICH patients with small hematomas. Methods This cohort study included 1,692 ICH patients treated between January 2018 and December 2020. Neurological rehabilitation was assessed using the modified Rankin Scale (mRS) at 3, 6, and 12 months, with mRS trajectories identified through a growth-based trajectory model. Affective and cognitive impairments were measured using standardized questionnaires, and their association with different mRS trajectories was analyzed using multivariate logistic regression. Results 1,563 patients were divided into two trajectories: early rehabilitation (75.5%) and late rehabilitation (24.5%). The late-rehabilitation group showed a higher prevalence of cognitive impairment and depression. After adjustment, late rehabilitation was linked to increased odds of cognitive impairment (OR 1.40, 95% CI 1.02–1.93, P = 0.036) and depression (OR 1.96, 95% CI 1.47–2.62, P < 0.001), but not anxiety. Subgroup analysis showed that males (OR 1.32, 95% CI 0.95–1.84, P = 0.003), hematoma volume ≤10.3 ml (OR 1.91, 95% CI 1.22–3.07, P = 0.014), third ventricle Sylvian fissure distance >38.48 mm (OR 2.04, 95% CI 1.36–3.08, P = 0.012), and higher education (OR 2.45, 95% CI 1.46–4.19, P = 0.016) were more prone to impairments in late rehabilitation group. Conclusion Early and sustained rehabilitation is crucial for reducing long-term cognitive and affective impairments following ICH. Personalized strategies are essential, especially for patients on a late-rehabilitation trajectory, to improve neuropsychiatric outcomes.