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OBJECTIVES: The prognostic significance of leukoaraiosis is still not completely elucidated. The objective was to examine survival and causes of death among elderly neurological patients with leukoaraiosis. METHODS: From 1 January 1994, vital status and causes of death were drawn from municipality lists and death certificates of 216 patients (mean age (SD) 70.6 (8.3) years) admitted to a geriatric unit who underwent cranial CT between 1 January 1984 and 31 December 1986 (mean observation period (SD) 8.4 (0.8) years). These patients had been enrolled for a study of clinical predictors of leukoaraiosis. Based on the presence of leukoaraiosis on CT, this group had been divided into two subgroups of patients, with and without leukoaraiosis. The difference in survival and causes of death between these groups formed the objective of the study. RESULTS: Survival time was shorter among the 90 patients with leukoaraiosis than among the 126 patients without (median survival time 4.07 v 7.78 years, log rank test P < 0.001). After controlling for age and other major death predictors, the risk of death remained significantly increased (relative risk (RR) = 1.64, 95% confidence interval (95% CI) 1.15-2.34) among patients with leukoaraiosis. Moreover, patients with leukoaraiosis had an almost threefold higher risk of dying from vascular causes than patients without (RR = 2.81, 95% CI 1.74-4.53). CONCLUSION: Leukoaraiosis is a predictor of vascular deaths in elderly neurological patients. Careful diagnostic evaluation and attention to preventive measures are required in patients with leukoaraiosis.