Abstract
Background: Cognitive impairment following a minor stroke or transient ischemic attack (TIA) is common; however, due to diagnostic difficulties, the prevalence and underlying cause of impairment remain poorly defined. We compared cognition in patients after a minor stroke, TIA, or mimic event at three time points in the first year following the event. We examine whether cognitive impairment occurs following these events and whether this impairment differs based on the event type. Further, we measure whether these findings persist after controlling for age, education, and the presence of vascular risk factors and whether the presence of vascular risk factors, independent of event etiology, is associated with cognitive impairment. Lastly, we investigate whether increased stroke risk, as assessed by the ABCD2, is associated with reduced cognition.Methods: Medical information, a cognitive screening test, and a measure of executive functioning were collected from 613 patients (123 minor stroke, 175 TIA, and 315 mimics) using phone interviews at three time points in the first year following the event. Linear mixed models were used to determine the effect of event type, vascular risk factors, and predicted stroke risk on cognitive performance while controlling for confounders.Results: There was no relationship between event type and performance on either cognitive measure. When all confounders are controlled for, performance on the cognitive screening test was uniquely accounted for by the presence of heart failure, myocardial infarction, angina, and hypertension (all p < 0.047), whereas the measure of executive functioning was uniquely accounted for by the presence of hypertension and angina (all p < 0.032). Increased stroke risk also predicted performance on the cognitive screening test and the measure of executive functioning (all p < 0.002).Conclusions: Our findings indicate that cognitive impairment following a minor stroke or TIA may be attributed to the high prevalence of chronic vascular risk factors in these patients. This highlights the importance of long-term management of vascular risk factors beyond event recovery to reduce the risk of cognitive impairment. Increased stroke risk (i.e., ABCD2 score) was also associated with reduced cognition, suggesting that it may be helpful in signaling the need for further cognitive evaluation and intervention post-event.
Highlights
Minor stroke and transient ischemic attack (TIA) are brief episodes of neurological dysfunction that lie on a spectrum of severity, with minor stroke considered a more severe neurological event [1]
As some nonvascular conditions mimic the symptoms of minor stroke and TIA [6], it is possible that some studies that do not include specialist diagnosis may inadvertently include a proportion of mimic patients for whom changes in cognitive functioning have not been established
We examine whether cognitive functioning varies as a function of event type and, if so, whether these differences can be attributed to the differential presence of vascular risk factors
Summary
Minor stroke and transient ischemic attack (TIA) are brief episodes of neurological dysfunction that lie on a spectrum of severity, with minor stroke considered a more severe neurological event [1]. While clinical symptoms are transient, there is increasing evidence of persistent moderate cognitive impairment [2, 3]. The rate of moderate (29–68%) and severe (5–22%) cognitive impairment varies across studies [3]. This variability is likely to be partly due to clinical factors that affect diagnosis, as symptoms are often resolved before clinical assessment and diagnosis is often based on clinician’s interpretation of the patients’ recollection of the event. Cognitive impairment following a minor stroke or transient ischemic attack (TIA) is common; due to diagnostic difficulties, the prevalence and underlying cause of impairment remain poorly defined. We investigate whether increased stroke risk, as assessed by the ABCD2, is associated with reduced cognition
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