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.