ORIGINAL RESEARCH article
Front. Neurol.
Sec. Cognitive and Behavioral Neurology
A nomogram model to predict cognitive impairment in patients with spontaneous intracerebral hemorrhage
Provisionally accepted
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Purpose Post-stroke cognitive impairment (PSCI) after spontaneous intracerebral hemorrhage (sICH) is highly prevalent and severely impacts patients' long-term quality of life. However, accurate prediction tools that integrate acute-phase complications with sociodemographic characteristics are currently lacking. This study aimed to identify independent risk factors for PSCI in sICH patients and to construct a visual nomogram prediction model to guide clinical risk stratification prior to hospital discharge. Methods We retrospectively analyzed clinical data from 264 sICH patients admitted to the Affiliated Hospital of Xuzhou Medical University between July 2023 and July 2025. Patients were classified into cognitive impairment and cognitively normal groups based on the Montreal Cognitive Assessment (MoCA) score (< 22). The dataset was randomly split into a training set (n=198, 75%) and a validation set (n=66, 25%). Univariate and multivariate logistic regression analyses were employed to screen for independent predictors, which were then used to construct the nomogram model. The model's discriminative ability, calibration, and clinical utility were validated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Results The overall incidence of PSCI in this cohort was 44.3%. Multivariate logistic regression analysis identified pulmonary infection (OR 3.980, 95% CI 2.075-7.635, P=0.002) and hematoma volume (OR 1.030, 95% CI 1.015-1.045, P<0.001) as independent risk factors for PSCI, whereas years of education (OR 0.885, 95% CI 0.831-0.944, P<0.001) served as an independent factor associated with reduced risk. The nomogram model demonstrated excellent discriminative ability with AUCs of 0.771 and 0.820 in the training and validation sets, respectively. Calibration curves indicated high consistency between predicted probabilities and observed outcomes. DCA confirmed clinical net benefit across a wide range of threshold probabilities. Conclusion This study successfully developed a nomogram prediction model incorporating pulmonary infection, hematoma volume, and years of education. The model suggests that cognitive decline after sICH is associated with a combination of systemic inflammation (brain-body axis interaction), primary structural injury, and insufficient cognitive reserve. This user-friendly and accurate scoring tool can assist clinicians in identification of high-risk subgroups for PSCI upon completion of inpatient care, thereby informing intensified clinical monitoring and rehabilitation planning.
Keywords: cognitive impairment, nomogram, pulmonary infection, Spontaneous intracerebral hemorrhage, Years of education
Received: 08 Dec 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Ren, Yu, Ye, Han, Song and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Liechi Yang
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.