Stroke-Related Acceleration of Brain Atrophy beyond Aging in the Framingham Study: Paired Pre- and Post-MRI Evidence and Cognitive Associations.

INTRODUCTION

Stroke induces structural brain disruption, accelerating cognitive decline. Using data from the Framingham Heart Study (FHS), we sought to separate aging-only vs. aging plus stroke atrophy rates and its cognitive correlates.

METHODS

We included cognitively intact FHS participants with first incident stroke. We include pre- and post-index MRIs in both stroke cases and matched controls (2:1), allowing us to estimate aging-only versus aging plus stroke atrophy rates. We computed annualized rates of change in brain volume metrics and cognitive decline, adjusting for relevant factors.

RESULTS

We included 45 stroke cases (67.8 ± 10.3 years, 17 (38%) female). Compared to controls, accelerated ipsilesional brain atrophy (adjusted Δ = -2.39 mm3/year, p < 0.001) and white matter hyperintensity progression (adjusted Δ = 0.71 mm3/year, p = 0.003) were observed. Voxel-based analysis revealed maximal atrophy subcortically. Accelerated atrophy correlated with global cognition and executive function decline among stroke survivors but not controls.

DISCUSSION: This paired-MRI study provides preliminary evidence that stroke modestly accelerates ipsilesional atrophy, predominantly in subcortical regions plausibly linked to processing-speed decline. These findings are hypothesis-generating and require validation in larger prospective studies before firm conclusions can be drawn.