Infratentorial cerebral microbleeds and brain age gap in stroke patients: a cross-sectional neuroimaging study.
| Title: | Infratentorial cerebral microbleeds and brain age gap in stroke patients: a cross-sectional neuroimaging study. |
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| Authors: | Pallapothu R; Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA. raghavpallapothu1@gmail.com.; Kudaravalli S; Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA. santosh.kudaravalli@gmail.com.; Newman-Norlund RD; Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA.; Pallapothu S; Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA.; Kannan PR; Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA.; Kummari SK; Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA.; Absher J; University of South Carolina School of Medicine, Greenville, SC, 29605, USA.; Clemson University School of Health Research, CUSHR, Clemson, SC, 29634, USA.; Departments of Medicine, Neurosurgery, and Radiology, Prisma Health, Greenville, SC, 29601, USA.; Rorden C; Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA. |
| Source: | GeroScience [Geroscience] 2026 Apr 15. Date of Electronic Publication: 2026 Apr 15. |
| Publication Model: | Ahead of Print |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Springer International Publishing Country of Publication: Switzerland NLM ID: 101686284 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2509-2723 (Electronic) Linking ISSN: 25092723 NLM ISO Abbreviation: Geroscience Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Cham : Springer International Publishing, [2017]- |
| Abstract: | Stroke survivors often face long-term cognitive and motor deficits. Brain age gap (BAG), the difference between chronological age and age estimated based on MRI data, has emerged as a biomarker for neurodegeneration. While prior work links BAG to stroke outcomes, the relationship between BAG and cerebral microbleeds (CMBs), particularly infratentorial CMBs common in hypertensive arteriopathy, remains unclear. The sensorimotor network (SMN) is highly susceptible to both direct and remote injury after stroke and is structurally and functionally interconnected with infratentorial regions via pathways such as the corticospinal tract. Vascular disruption in the cerebellum or brainstem may therefore have downstream effects on supratentorial SMN regions, making this network a biologically relevant target for investigating BAG-CMB relationships. We analyzed data from 1725 stroke patients in the Stroke Outcomes Optimization Projects. Two trained raters manually counted infratentorial CMBs on susceptibility-weighted MRI images (SWI), while BAG was computed using the automated volBrain BrainStructureAges pipeline on T1-weighted images. Spearman correlations tested associations between CMB count and regional BAG in 14 a priori brain regions of interest (ROI) and results were conditioned for age, sex, race, white matter hyperintensities, hypertension, type of scanner, and total ischemic lesion volume. Infratentorial CMB count was positively correlated with BAG in 9/14 sensorimotor regions: right precentral gyrus medial segment (r (213) = 0.186, p = 0.007), left precentral gyrus medial segment (r (213) = 0.186, p = 0.007), right postcentral gyrus medial segment (r (213) = 0.202, p = 0.004), right postcentral gyrus (r (213) = 0.202, p = 0.004), left postcentral gyrus (r (213) = 0.161, p = 0.021), right parietal operculum (r (213) = 0.198, p = 0.004), right central operculum (r (213) = 0.195, p = 0.005), right precentral gyrus (r (213) = 0.184, p = 0.008), and left postcentral gyrus medial segment (r (213) = 0.192, p = 0.006). Our findings suggest that infratentorial microvascular injury is associated with accelerated aging in functionally connected motor cortices. This supports a network-level model of stroke-related brain aging, with implications for predicting sensorimotor outcomes. BAG may serve as a sensitive marker for cerebrovascular injury and guide targeted rehabilitation efforts.; (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval: This study was approved by the University of South Carolina's Institutional Review Board. Consent to participate: A HIPAA waiver and waiver of consent were authorized for individual participants included in the study. Competing interests: The authors declare no competing interests. |
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| Grant Information: | RF1MH133701 National Institute of Health |
| Contributed Indexing: | Keywords: Brain; Brain age gap; Cerebral microbleeds; Stroke |
| Entry Date(s): | Date Created: 20260414 Latest Revision: 20260414 |
| Update Code: | 20260415 |
| DOI: | 10.1007/s11357-026-02218-7 |
| PMID: | 41981356 |
| Database: | MEDLINE |
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