First-Time Transient Ischemic Attack Associated With Long-Term Cognitive Decline

By Rob Dillard - Last Updated: February 10, 2025

Transient ischemic attack (TIA) is associated with long-term cognitive decline, according to a study published in JAMA Neurology. 

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“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,” the researchers noted.

In this secondary data study, researchers assessed individuals from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. 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. The primary end point of interest was defined as composite standardized z score. Overall, the study assessed 356 individuals with with first-time TIA and 14,882 asymptomatic controls.

The study found that the overall cognitive composite before index event of TIA 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. Following TIA, the researchers observed 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).

“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,” the researchers concluded.

 

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