title: Medial temporal atrophy rather than white matter hyperintensities predict cognitive decline in stroke survivors.
abstract: Stroke is an important risk factor for dementia, but the exact mechanisms involved in cognitive decline remain unclear. In this study, we related baseline MRI brain measures with later cognitive decline. Seventy-nine stroke survivors aged 75+ years without dementia were recruited 3-month post-stroke. They underwent yearly neuropsychological assessments and had an MRI at baseline and 2 years. Medial temporal lobe atrophy (MTA) was scored and volume of white matter hyperintensities (WMH) was measured at baseline. The rate of ventricular enlargement was measured by comparing the baseline and repeat images. Linear regression indicated that memory loss was related to both baseline memory and MTA (p=0.001; standardized regression coefficient beta=-0.35) but not WMH volume. The only independent predictor of ventricular enlargement was MTA (p=0.003; beta=0.47). However, no baseline MRI variable differed between those who did (18%) and did not (82%) develop dementia. The association of MTA but not WMH with subsequent cognitive decline and increasing brain atrophy suggests a greater role for Alzheimer type than vascular pathology in delayed cognitive impairment after stroke.
authors.affiliation: Institute for Ageing and Health, University of Newcastle, Wolfson Research Centre, Newcastle upon Tyne NE4 6BE, UK. m.j.firbank@ncl.ac.uk
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Firbank
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Burton
authors.forename: Robert
authors.initials: R
authors.lastname: Barber
authors.forename: Sally
authors.initials: S
authors.lastname: Stephens
authors.forename: Rose Anne
authors.initials: RA
authors.lastname: Kenny
authors.forename: Clive
authors.initials: C
authors.lastname: Ballard
authors.forename: Raj N
authors.initials: RN
authors.lastname: Kalaria
authors.forename: John T
authors.initials: JT
authors.lastname: O'Brien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000473:pathology / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis / Q000473:pathology* / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D011237:Predictive Value of Tests; D020521:Stroke / Q000175:diagnosis / Q000473:pathology* / Q000523:psychology; D017741:Survivors; D013702:Temporal Lobe / Q000473:pathology*