Question When controlling for vascular and demographic factors, does transient ischemic attack confer an independent risk for cognitive decline?
Findings In this longitudinal cohort study (Reasons for Geographic and Racial Differences in Stroke [REGARDS]), pre-event and postevent cognitive trajectories were compared in 356 individuals with TIA, 965 individuals with stroke, and 14 882 asymptomatic controls. A single, diffusion-weighted image–negative, adjudicated TIA was a risk factor for cognitive decline, independent of vascular and demographic risk factors, with an estimated annual decline similar to a single ischemic stroke.
Meaning TIA-associated cognitive decline suggests a need to reevaluate post-TIA management and to screen regularly for cognitive change.
Importance Prior research suggests reduced cognitive function after transient ischemic attack (TIA). Whether this is directly related to the TIA, a function of preexisting risk factors, or prior cognitive decline remains unclear.
Objective To study if a single, diffusion-weighted image–negative, adjudicated TIA is associated with longitudinal declines in cognition, independent of preexisting risk factors.
Design, Setting, and Participants This was a secondary data analysis from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort following up 30 239 Black and White participants for incident cerebrovascular events. The setting consisted of telephone cognitive assessments. Participants were individuals with first-time TIA, first-time stroke, and asymptomatic community control groups with neuroimaging used for adjudication.
Exposures First-time TIA and stroke.
Main Outcomes and Measures Verbal fluency and memory measures administered biannually. Primary outcome was a composite standardized z score, with secondary outcomes individual test performances. Adjusted segmented regression models characterized pre-event and postevent cognition and annual cognitive change.
Results Included in the study were 356 individuals with first-time TIA (mean [SD] age, 66.6 [8.7]; 188 female [53%]) and 965 individuals with first-time stroke (mean [SD] age, 66.8 [8.2]; 494 male [51%]). A total of 14 882 individuals (mean [SD] age, 63.2 [8.6] years; 8439 female [57%]) were included in the asymptomatic control group. Overall cognitive composite before index event was lower in the stroke (−0.25; 95% CI, −0.32 to −0.17) than TIA (−0.05; 95% CI: −0.17 to 0.07; P = .005) and asymptomatic (0; 95% CI, −0.03 to 0.03; P < .001) groups. After the index event, the cognitive composite of the group with stroke significantly declined (−0.14; 95% CI, −0.21 to −0.07) compared with that of the group with TIA (0.01; 95% CI, −0.10 to 0.12; P = .02) and controls (−0.03; 95% CI, −0.05 to −0.01; P = .003). The annual decline after the index event was faster (P = .001) in the group with TIA (−0.05; 95% CI, −0.06 to −0.03) than that for asymptomatic controls (−0.02; 95% CI, −0.02 to −0.02) but not different from the group with stroke (−0.04; 95% CI, −0.05 to −0.03; P = .43).
Conclusions and Relevance Results of this cohort study suggest that despite the quick resolution of stroke symptoms in TIA, there was apparently sufficient impact to be associated with long-term cognitive decline. Whether the underlying mechanisms are by direct or secondary injury and/or interaction with concomitant neurodegenerative factors remains to be elucidated.
https://jamanetwork.com/journals/jamaneurology/article-abstract/2830012
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