Clinical and neuroimaging features, and associations with early post-stroke cognition in patients with intracerebral hemorrhage in Taiwan

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute spontaneous intracerebral hemorrhage (ICH) (n=202). Intervention: Lobar intracerebral hemorrhage (ICH) vs. Non-lobar intracerebral hemorrhage (ICH). Primary outcome: Early global cognitive performance measured by Mini-Mental State Examination (MMSE) at 1 to 2 months post-ICH (p=0.026).

Q: What does this research mean for the field?

Lobar intracerebral hemorrhage is associated with significantly worse early post-stroke cognitive performance compared to non-lobar intracerebral hemorrhage. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chung‐Fen Tsai; Sung‐Chun Tang; Ya-Hui Wang; Chih‐Hao Chen; Kristiina Rannikmäe; Ping‐Keung Yip; Jiann‐Shing Jeng

doi:10.1371/journal.pone.0358545

September 21, 2026PLoS ONEOpen Access

Clinical and neuroimaging features, and associations with early post-stroke cognition in patients with intracerebral hemorrhage in Taiwan

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Key result

Lobar ICH was associated with worse early post-stroke cognitive performance compared to non-lobar ICH.

Why the study?

Clinical and neuroimaging characteristics, genetic and vascular risk factors, and prognosis of intracerebral hemorrhage may vary between populations, necessitating investigation in Chinese patients in Taiwan.

How do clinical, genetic, and neuroimaging features differ between lobar and non-lobar (or CAA vs non-CAA) intracerebral hemorrhage, and what factors are associated with early post-stroke cognitive performance in Chinese patients in Taiwan?

Key Points

To compare clinical, genetic, and neuroimaging characteristics between lobar and non-lobar intracerebral hemorrhage, and to identify factors associated with early post-stroke cognitive performance.
Prospectively recruited 202 acute spontaneous Chinese intracerebral hemorrhage (ICH) patients from two large hospitals in Taiwan.
Evaluated vascular risk factors, APOE genotypes, and CT/MRI neuroimaging markers including cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS).
Assessed early post-stroke global cognition at approximately 1 month via MMSE (N=134) and MoCA (N=119), evaluating determinants using generalized linear models.
Compared to non-lobar ICH (N=161), lobar ICH (N=41) was associated with older age (mean 66.4 vs 58.8 years, p = 0.001), larger ICH volume (mean 49 ml vs 16 ml, p < 0.001), higher 1-month case fatality (7% vs 0%, p = 0.008), and a lower rate of hypertension (85% vs 98%, p < 0.001).
Patients with lobar ICH had significantly more lobar CMBs (mean 9.0 vs 3.3, p < 0.001), higher rates of cSS (50% vs 4%, p < 0.001), and poorer cognitive performance on both the MMSE (mean 20.9 vs 24.2, p = 0.026) and MoCA (mean 17.3 vs 21.0, p = 0.023).
Generalized linear regression revealed that age, education, initial conscious level (GCS), stroke severity (NIHSS), ICH volume, and lobar CMB burden were significantly associated with early post-stroke cognitive performance.

Study Design

Type

Cohort (n=202)

Blinding

Genotypers were blind to clinical information and image findings; image reading was performed independently by two trained observers blinded to genetic tests.

Multicenter

Yes

Structured PICO

How do clinical, genetic, and neuroimaging features differ between lobar and non-lobar (or CAA vs non-CAA) intracerebral hemorrhage, and what factors are associated with early post-stroke cognitive performance in Chinese patients in Taiwan?

P

Population

202 adult Chinese patients in Taiwan with acute spontaneous intracerebral hemorrhage (mean age 60.5 years, 35% female) recruited from two hospitals and assessed for early post-stroke cognition at 1 to 2 months.

E

Exposure

Lobar intracerebral hemorrhage (ICH) location (n=41) and cerebral amyloid angiopathy (CAA) etiology (n=25), evaluated alongside clinical, genetic (APOE ε4 genotype), and neuroimaging markers (ICH volume, cerebral microbleeds [CMBs], cortical superficial siderosis [cSS])

C

Comparator

Non-lobar (deep) intracerebral hemorrhage (ICH) location (n=161) and non-CAA etiology (n=177)

O

Outcome

Early post-stroke global cognitive function assessed between the first and second month after ICH using the Taiwanese version of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)surrogate

Main Result

Absolute Event Rate: 20.9% vs 24.2%

p-value: p=0.026

Limitations

Hospital-based study with a relatively small sample size, particularly in the probable CAA subgroup, which may not be fully representative of all Chinese or Asian ICH patients.
Selection bias due to 33% of patients being unable to undergo cognitive assessment because of unstable hemodynamics, poor conscious level, or early mortality.
MMSE and MoCA do not provide comprehensive cognitive assessment for specific cognitive domains.
Cognitive evaluation was performed between the first and second month after ICH and does not represent long-term cognitive outcome.
Prospective, hospital-based study in Taiwan without a large sample size, which might not be fully representative of all Chinese or Asian ICH patients
Small sample size of probable CAA group (n=25) precluded further subgroup analysis and reduced statistical power
Systematic selection bias as 33% of patients could not undergo cognitive assessment due to unstable hemodynamics, poor conscious level, or early mortality
MMSE and MoCA could not provide comprehensive cognitive assessment for specific cognitive domains
Cognitive evaluation was performed between the first and second month after ICH and could not represent long-term cognitive outcome

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

In Chinese patients with acute spontaneous ICH in Taiwan, non-lobar hemorrhage and hypertension predominate, while lobar ICH, CAA, larger hematoma volume, and higher lobar cerebral microbleed burden are strongly associated with worse early post-stroke cognitive function.

Abstract

BACKGROUND: East Asians have a higher incidence rate of intracerebral hemorrhage (ICH). As clinical and neuroimaging characteristics, genetic and vascular risk factors, and prognosis might vary between populations, we aimed to make comparisons between different ICH locations and etiologies, and to investigate the factors associated with early post-stroke cognition in Chinese patients in Taiwan. METHODS: We prospectively recruited acute spontaneous Chinese ICH patients from two large Hospitals in Taiwan. For included patients, we compared major vascular risk factors, APOE genotypes, clinical and neuroimaging features, and early post-stroke cognition in patients with lobar versus non-lobar ICH and in cerebral amyloid angiopathy (CAA) versus non-CAA group. Furthermore, we used generalized linear models to investigate the associated factors with early global cognitive performance after ICH. RESULTS: In 202 included acute spontaneous ICH patients, 65% were men. 80% were non-lobar ICH, and 20% were lobar ICH. Lobar ICH patients generally had an older age, worse conscious level, a higher 1-month case fatality, a larger ICH volume, more lobar CMBs and cortical superficial siderosis, and worse early post-stroke cognitive function, while non-lobar patients had a higher proportion of hypertension (98% vs 85%, p < 0.001). Similar findings were noted when comparing patients of CAA group with non-CAA groups. Generalized linear regression models revealed that age, education, initial conscious level, stroke severity, ICH volume and lobar CMB burden were associated with early post-stroke cognition in ICH patients. CONCLUSION: Our study demonstrated the differences in clinical and imaging features, major risk factors, and early post-stroke cognitive function between different locations and etiologies in Chinese ICH patients in Taiwan. Age, education, stroke severity, ICH volume and lobar CMB burden were the associated factors for early global cognitive performance after ICH.

Discussion

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Cite This Study

Tsai et al. (2026) conducted a cohort in Acute spontaneous intracerebral hemorrhage (ICH) (n=202). Lobar intracerebral hemorrhage (ICH) vs. Non-lobar intracerebral hemorrhage (ICH) was evaluated on Early global cognitive performance measured by Mini-Mental State Examination (MMSE) at 1 to 2 months post-ICH (p=0.026). Lobar ICH was associated with worse early post-stroke cognitive performance compared to non-lobar ICH.

synapsesocial.com/papers/6ac4aa774a9183ebb2ba720d https://doi.org/10.1371/journal.pone.0358545

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Clinical and neuroimaging features, and associations with early post-stroke cognition in patients with intracerebral hemorrhage in Taiwan

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Clinical and neuroimaging features, and associations with early post-stroke cognition in patients with intracerebral hemorrhage in Taiwan

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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