title: Age related white matter changes predict stroke death in long term follow-up.
abstract: OBJECTIVE
  Recurrent strokes and functional decline are predicted by age related white matter changes (ARWMC). Whether they are associated with long term survival among hospital patients referred for acute stroke is not known.
  
  
  METHODS
  A total of 396 consecutive acute stroke patients subjected to MRI were included in the study and followed-up for up to 12 years.
  
  
  RESULTS
  28% had mild, 18% had moderate and 54% had severe ARWMCs. In Kaplan-Meier analysis, poor survival was predicted by severe ARWMCs (p<0.0001), cardiac failure (CF, p<0.0001), atrial fibrillation (AF, p<0.0001), other arrhythmias (p = 0.003), peripheral arterial disease (PAD, p = 0.004) and poor modified Rankin score (mRS) (p<0.0001). ARWMC was related to death by all brain related causes, especially ischaemic stroke (p<0.0001). In stepwise Cox regression analysis adjusted with significant risk factors, severe ARWMCs (hazard ratio (HR) 1.34, 95% CI 1.03 to 1.73; p = 0.029), age (HR 1.07, 95% CI 1.05 to 1.09; p<0.0001), CF (HR 1.59, 95% CI 1.17 to 2.15; p = 0.003), AF (HR 1.68, 95% CI 1.24 to 2.27; p = 0.001), PAD (HR 1.59, 95% CI 1.11 to 2.26; p = 0.011), diabetes (HR 1.44, 95% CI 1.08 to 1.92; p = 0.013), smoking (HR 1.60, 95% CI 1.23 to 2.08; p<0.0001) and mRS (HR 1.65, 95% CI 1.26 to 2.14; p<0.0001) were independently associated with death from all causes. Severe ARWMCs (HR 1.80, 95% CI 1.10 to 2.96; p = 0.019), age (HR 1.05, 95% CI 1.01 to 1.09; p = 0.009), AF (HR 1.82, 95% CI 1.08 to 3.07; p = 0.026), PAD (HR 2.17, 95% CI 1.19 to 3.95; p = 0.012) and mRS (HR 2.75, 95% CI 1.67 to 4.54; p<0.0001) were specifically associated with death from brain related causes.
  
  
  CONCLUSIONS
  In patients with acute stroke, ARWMC seems to be a significant predictor of poor long term survival and death by ischaemic stroke.
authors.affiliation: Department of Surgery and Forensic Medicine, Medical School, University of Tampere and Tampere University Hospital, 33014 University of Tampere, Finland. niku.oksala@tuubi1.net
authors.forename: N K J
authors.initials: NK
authors.lastname: Oksala
authors.forename: A
authors.initials: A
authors.lastname: Oksala
authors.forename: T
authors.initials: T
authors.lastname: Pohjasvaara
authors.forename: R
authors.initials: R
authors.lastname: Vataja
authors.forename: M
authors.initials: M
authors.lastname: Kaste
authors.forename: P J
authors.initials: PJ
authors.lastname: Karhunen
authors.forename: T
authors.initials: T
authors.lastname: Erkinjuntti
mesh_terms: D000208:Acute Disease; D000368:Aged; D000375:Aging / Q000473:pathology*; D001145:Arrhythmias, Cardiac / Q000150:complications; D001281:Atrial Fibrillation / Q000150:complications; D001921:Brain / Q000473:pathology*; D003920:Diabetes Mellitus / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D016491:Peripheral Vascular Diseases / Q000150:complications; D011379:Prognosis; D012044:Regression Analysis; D018570:Risk Assessment; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000401:mortality* / Q000473:pathology*; D013997:Time Factors