Impact of Cerebral Small Vessel Disease on Functional Recovery after Intracerebral Hemorrhage: Stratified Analysis by Age

Background Cerebral small vessel disease (cSVD) is a major contributor to intracerebral hemorrhage (ICH). Its presence carries significant implications for stroke prevention, acute management, post-stroke recovery, and socioeconomic burden. Despite its clinical significance, the impact of cSVD on functional outcomes after ICH, particularly concerning aging remains uncertain. Objective This study evaluated how cSVD influences post-ICH functional recovery, using age stratification (< 65 and ≥65 years) and a multidomain functional assessment approach. Methods We retrospectively analyzed data from 356 patients with primary spontaneous ICH. Functional status was evaluated at baseline and at 3 months post-ICH across multiple domains, including global disability, activities of daily living, gait, upper extremity function, and swallowing ability, using validated assessment tools. Patients were categorized based on age and the presence or absence of cSVD. Results Patients without cSVD consistently exhibited better functional status than those with cSVD at both baseline and 3-month evaluations across age groups. Although all groups showed statistically significant functional improvement over time, the degree of improvement was significantly lower in patients with cSVD, particularly among those aged 65 years or older. Multivariable logistic regression analysis confirmed that cSVD was a strong and independent predictor of poor functional outcomes at 3 months after ICH. Conclusion Our findings emphasize that cSVD is not merely a passive comorbidity but an active and independent determinant of poor prognosis and limited recovery following ICH. The clinical importance of early detection of cSVD and support the need for more intensive, individualized rehabilitation strategies in ICH survivors.