Structural MRI markers of brain aging early after ischemic stroke

Abstract

Objective:To examine associations between ischemic stroke, vascular risk factors, and MRI markers of brain aging.Methods:Eighty-one patients (mean age 67.5 ± 13.1 years, 31 left-sided, 61 men) with confirmed first-ever (n = 66) or recurrent (n = 15) ischemic stroke underwent 3T MRI scanning within 6 weeks of symptom onset (mean 26 ± 9 days). Age-matched controls (n = 40) completed identical testing. Multivariate regression analyses examined associations between group membership and MRI markers of brain aging (cortical thickness, total brain volume, white matter hyperintensity [WMH] volume, hippocampal volume), normalized against intracranial volume, and the effects of vascular risk factors on these relationships.Results:First-ever stroke was associated with smaller hippocampal volume (p = 0.025) and greater WMH volume (p = 0.004) relative to controls. Recurrent stroke was in turn associated with smaller hippocampal volume relative to both first-ever stroke (p = 0.017) and controls (p = 0.001). These associations remained significant after adjustment for age, sex, education, and, in stroke patients, infarct volume. Total brain volume was not significantly smaller in first-ever stroke patients than in controls (p = 0.056), but the association became significant after further adjustment for atrial fibrillation (p = 0.036). Cortical thickness and brain volumes did not differ as a function of stroke type, infarct volume, or etiology.Conclusions:Brain structure is likely to be compromised before ischemic stroke by vascular risk factors. Smaller hippocampal and total brain volumes and increased WMH load represent proxies for underlying vascular brain injury.

Predicted Brain Age After Stroke

“…The proposal that stroke is specifically associated with accelerated brain aging prior and after stroke has been made by several authors. Neuroimaging markers of brain aging, such as smaller hippocampal and total brain volumes, and increased white matter hyperintensity load, have been linked to both, vascular brain injury prior to the stroke event (Seshadri et al, 2004;Knopman and Hooshmand, 2017;Werden et al, 2017) and continued brain atrophy and neurodegeneration (Knopman et al, 2009;Kooi Ong et al, 2017). For acute stroke, it has been estimated that during stroke or transient ischemeic attack (TIA), compared with the normal rate of neuronal loss in brain aging, the ischemic brain ages 3.6 years each hour without treatment (Saver, 2006).…”

Medial Temporal Atrophy in Amyloid-Negative Amnestic Type Dementia Is Associated with High Cerebral White Matter Hyperintensity

“…Additionally, many studies have demonstrated a relationship between neurodegeneration and cerebrovascular disease (CVD). For instance, Werden and colleagues [12] found lower hippocampal volumes among first-ever and recurrent stroke patients. Post-stroke victims also had significantly lower ipsilateral hippocampal volume than healthy controls [13].…”

Development of a cerebrovascular magnetic resonance imaging biomarker for cognitive aging

“…Due to the increasing evidence that brain changes are seen prior to visible cerebrovascular injury on fluid‐attenuated inversion recovery (FLAIR; ie, WMH and macroscopic infarctions7, 8, 9, we focused on MRI measures that captured brain health and did not include FLAIR findings.…”

“…[3][4][5][6] Recent work has also shown that these changes precede the appearance of overt brain lesions. 7,8 The inability to quantify the effect of systemic vascular health on early brain structural and functional changes in a meaningful View this article online at wileyonlinelibrary.com.…”