Abstract
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 three 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 three-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 three months after ICH. Conclusions: 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 supports the need for more intensive, individualized rehabilitation strategies in ICH survivors.