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Updated: Jun 25, 2026
A Versatile Murine Model of Subcortical White Matter Stroke for the Study of Axonal Degeneration and White Matter Neurobiology
Published on: March 17, 2016
Age related white matter changes predict stroke death in long term follow-up
N K J Oksala1, A Oksala, T Pohjasvaara
1Department of Surgery and Forensic Medicine, Medical School, University of Tampere and Tampere University Hospital, 33014 University of Tampere, Finland. niku.oksala@tuubi1.net
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.
Insights
Severe age-related white matter changes (ARWMC) predict poor long-term survival in acute stroke patients. These changes are linked to increased mortality from all causes, especially ischemic stroke.
Area of Science:
- Neurology
- Geriatrics
- Radiology
Background:
- Age-related white matter changes (ARWMC) are known predictors of recurrent strokes and functional decline.
- The association between ARWMC and long-term survival in acute stroke patients remains unclear.
Purpose of the Study:
- To investigate the association between ARWMC and long-term survival in hospitalized patients with acute stroke.
- To determine if ARWMC independently predicts mortality from all causes and brain-related causes.
Main Methods:
- A cohort of 396 consecutive acute stroke patients undergoing MRI was followed for up to 12 years.
- Kaplan-Meier analysis and stepwise Cox regression were used to assess survival predictors.
- Severity of ARWMC was categorized as mild, moderate, or severe.
Main Results:
- Severe ARWMC was observed in 54% of patients.
- Severe ARWMC independently predicted death from all causes (HR 1.34) and brain-related causes (HR 1.80).
- Other significant predictors of mortality included age, cardiac failure, atrial fibrillation, peripheral arterial disease, diabetes, smoking, and modified Rankin score.
Conclusions:
- ARWMC is a significant independent predictor of poor long-term survival in acute stroke patients.
- Severe ARWMC is specifically associated with an increased risk of death from ischemic stroke.
- These findings highlight the importance of assessing ARWMC in stroke management and prognosis.