Long duration tree-ring records with annual precision allow for the reconstruction of past growing conditions. Investigations limited to the most common tree-ring proxy of ring width can be difficult to interpret, however, because radial growth is affected by multiple environmental processes. Furthermore, studies of living trees may miss important effects of drought on tree survival and forest changes. Stable carbon isotopes can help distinguish drought from other environmental factors that influence tree-ring width and forest stand condition. We quantified tree-ring radial expansion and stable carbon isotope ratios (δ¹³C) in riparian cottonwoods (Populus angustifolia and P. angustifolia x P. trichocarpa) along Snake Creek in Nevada, USA. We investigated how hydrological drought affected tree growth and death at annual to half-century scales in a partially dewatered reach (DW) compared to reference reaches immediately upstream and downstream. A gradual decline in tree-ring basal area increment (BAI) began at DW concurrent to streamflow diversion in 1961. BAI at DW diverged from one reference reach immediately but not from the other until nearly 50 years later. In contrast, tree-ring δ¹³C had a rapid and sustained increase following diversion at DW only, providing the stronger and clearer drought signal. BAI and δ¹³C were not significantly correlated prior to diversion; after diversion they both reflected drought and were correlated for DW trees only. Cluster analyses distinguished all trees in DW from those in reference reaches based on δ¹³C, but BAI patterns left trees intermixed across reaches. Branch and tree mortality were also highest and canopy vigor was lowest in DW. Results indicate that water scarcity strongly limited cottonwood photosynthesis following flow diversion, thus reducing carbon assimilation, basal growth and survival. The dieback was not sudden, but occurred over decades as carbon deficits mounted and depleted streamflow left trees increasingly vulnerable to local meteorological drought.