AbstractBackgroundTo investigate the association between cerebral amyloid deposition and long‐term cognitive outcomes in patients with hemorrhagic small vessel disease (SVD) and survivors of intracerebral hemorrhage (ICH).MethodsPatients experiencing an ICH without overt dementia were prospectively recruited (n = 68) for brain MRI and Pittsburgh compound B (PiB) positron emission tomography scans at baseline. Cognitive function was assessed using the mini‐mental status examination (MMSE) and clinical dementia rating after an overall median follow‐up of 3.8 years. A positive amyloid scan was defined as a global PiB standardized uptake value ratio >1.2. Associations between follow‐up cognitive outcomes and neuroimaging markers were explored using multivariable Cox regression models.ResultsPiB(+) patients were older (72.1 ± 7.8 vs. 59.9 ± 11.7, p = .002) and more frequently had cerebral amyloid angiopathy (CAA) (63.6% vs. 15.8%, p = .002) than PiB(−) patients. PiB(+) was associated with a higher risk of dementia conversion (32.9 vs. 4.0 per 100‐person‐years, hazard ratio [HR] = 15.7 [3.0–80.7], p = .001) and MMSE score decline (58.8 vs. 9.9 per 100‐person‐years, HR = 6.2 [1.9–20.0], p = .002). In the non‐CAA subgroup (n = 52), PiB(+) remained an independent predictor of dementia conversion, p = .04). In the Cox models, PiB(+) was an independent predictor of dementia conversion (HR = 15.8 [2.6–95.4], p = .003) and MMSE score decline (HR = 5.7 [1.6–20.3], p = .008) after adjusting for confounders.ConclusionsCerebral amyloid deposition potentially contributes to long‐term cognitive decline in SVD‐related ICH.