Neuroimaging predictors of death and dementia in a cohort of older stroke survivors

BACKGROUND: Stroke is a risk factor for subsequent death and dementia. Being able to identify subjects at particular risk would be beneficial to inform treatment and patient management. METHODS SUBJECTS: aged over 75 years with incident stroke were recruited. Subjects had a cognitive assessment at 3 months post stroke to exclude dementia, and had an MRI scan (n=106) at that time. Subjects were then followed longitudinally for incident dementia and/or death. RESULTS: Independent neuroimaging predictors of survival to dementia were medial temporal atrophy (MTA; p=0.013) and the presence of thalamic infarcts (p=0.002). After inclusion of cognitive score in the model, the significance of MTA (p=0.049) and thalamic infarcts (p=0.04) was reduced, with survival being best predicted by baseline cognitive score (p=0.004). The only independent significant predictor of survival to death was MTA. Apart from thalamic infarcts, the NINDS/AIREN neuroimaging criteria did not independently predict survival to death or dementia. CONCLUSIONS: MTA was associated with shorter time to dementia, suggesting a role for Alzheimer pathology in the development of post stroke dementia.