Cognition in the First Year After a Minor Stroke, Transient Ischemic Attack, or Mimic Event and the Role of Vascular Risk Factors

As far as I can tell this is totally useless. Describes a problem, offers no solution. So after this type of event you are completely on your own to figure out your own treatment. And yet you still will have to pay your doctor for nothing.  THIS IS WHY SURVIVORS NEED TO BE IN CHARGE, they wouldn't allow such research to continue unless it provided solutions. 

Cognition in the First Year After a Minor Stroke, Transient Ischemic Attack, or Mimic Event and the Role of Vascular Risk Factors

Korinne Nicolas^1,2,3, Christopher Levi^2,3,4,5, Tiffany-Jane Evans¹, Patricia T. Michie^1,2, Parker Magin^1,2,3, Debbie Quain^1,2, Andrew Bivard^3,6 and Frini Karayanidis^1,2,3*

• ¹Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle, Newcastle, NSW, Australia
• ²Brain and Mental Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
• ³Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
• ⁴University of New South Wales, Sydney, NSW, Australia
• ⁵Sydney Partnership for Health, Education, Research and Enterprise, Sydney, NSW, Australia
• ⁶Melbourne Brain Center, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia

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.