Journal Article

Neuroimaging Markers of Brain Reserve and Associations with Delirium in Patients with Intracerebral Hemorrhage

Zhou, Helen Y., Boxerman, Jerrold L., Eloyan, Ani, Reznik, Michael E., Rex, Nathaniel B., Yi, Thomas Y., Bai, Harrison X., Collins, Scott A., Chuck, Carlin C., Jones, Richard N., Boukrina, Olga, Dandapani, Hari G., Girard, Timothy D.

2025

Overview

Background Delirium occurs frequently in patients with stroke, but the role of preexisting neural substrates in delirium pathogenesis remains unclear. We sought to explore associations between acute and chronic neural substrates of delirium in patients with intracerebral hemorrhage (ICH). Methods Using data from a single-center ICH registry, we identified consecutive patients with acute nontraumatic ICH and available magnetic resonance imaging scans. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were used to classify each patient as delirious or nondelirious during their hospitalization. Magnetic resonance imaging scans were processed and analyzed using semiautomated software, with volumetric measurement of acute ICH volume as well as white matter hyperintensity volume (WMHV) and gray and white matter volumes from the contralateral hemisphere. We tested associations between WMHV and incident delirium using multivariable regression models, and then determined the predictive accuracy of these neuroimaging models via area under the curve (AUC) analysis. Results Of 139 patients in our cohort (mean [standard deviation] age 67.3 [17.3] years, 53% male), 58 (42%) patients experienced delirium. In our primary analyses, WMHV was significantly associated with delirium after adjusting for ICH features (odds ratio 1.56 per 10 cm 3 , 95% confidence interval 1.13–2.13), and this association was strengthened after further adjustment for segmented brain volume in patients with high-resolution scans (odds ratio 1.89 per 10 cm 3 , 95% confidence interval 1.24–2.86). Neuroimaging-based models predicted delirium with high accuracy (AUC 0.81), especially in patients with Glasgow Coma Scale score > 13 (AUC 0.85) and smaller ICH (AUC 0.91). Conclusions Chronic white matter disease is independently associated with delirium in patients with acute ICH, and neuroimaging biomarkers may have utility in predicting delirium occurrence.

• Publisher: Springer US,Springer Nature B.V
• Subject: Aged / Aged, 80 and over / Atrophy / Biomarkers / Brain research / Cerebral Hemorrhage - complications / Cerebral Hemorrhage - diagnostic imaging / Cerebral Hemorrhage - epidemiology / Cerebral Hemorrhage - pathology / Cerebral Hemorrhage - physiopathology / Critical Care Medicine / Delirium / Delirium - diagnostic imaging / Delirium - epidemiology / Delirium - etiology / Delirium - physiopathology / Edema / Female / Gray Matter - diagnostic imaging / Gray Matter - pathology / Hemorrhage / Hospitalization / Humans / Intensive / Internal Medicine / Magnetic Resonance Imaging / Male / Medical imaging / Medicine / Medicine & Public Health / Mental disorders / Middle Aged / Neuroimaging / Neurology / Neurosurgery / Original Work / Patients / Registration / Registries / Review boards / White Matter - diagnostic imaging / White Matter - pathology