Individuals who have a transient ischemic attack (TIA), also known as a mini stroke, are likely to experience an annual rate of cognitive decline similar to that experienced by people with stroke, according to a report in JAMA Neurology.
Lead author Victor Del Bene, Ph.D., of the University of Alabama, and colleagues said the findings call for more aggressive screening and treatment following TIA to minimize cognitive risks. “Despite the quick resolution of symptoms and no radiological evidence of injury, TIA appears to be sufficient either directly or indirectly to initiate a pathological process leading to long-term changes in cognition,” they wrote.
The researchers analyzed data from the Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort following more than 30,000 community-dwelling Black and White adults in the United States. For this report, they examined cognitive outcomes of 356 individuals diagnosed with first-time TIA after enrolling, 965 individuals diagnosed with first-time stroke, and 14,882 adults with neither event (asymptomatic community control group). TIA was defined as an acute ischemic event that resolved in less than 24 hours and showed up negative for injury on an MRI scan.
A computer-assisted telephone interview was used to collect baseline demographic and medical data, and to administer a cognitive test battery including assessments of verbal learning, verbal recall, cognitive processing speed, and executive function at two-year intervals. The primary outcome was a composite score on the four tests; secondary outcomes included individual test scores.
The group with stroke showed a significantly larger decline in cognition immediately following their event compared with the group with TIA. However, the subsequent annual rate of cognitive decline for the group with TIA did not differ significantly from the group with stroke and was more pronounced than seen among the asymptomatic community control group. Individual test scores showed these changes were driven largely by declines in immediate and delayed memory recall rather than verbal fluency.
Del Bene and colleagues wrote that “cognitive decline after TIA is likely multifactorial in origin” and may involve the interaction with vascular risk factors, the presence of amyloid in the brain, and increased neuroinflammation, among other pathophysiological processes.
For related information, see the Psychiatric News article “Poor Quality Sleep in Midlife Linked to Poor Cognition 11 Years Later.”
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