Cognitive decline after first-time transient ischemic attack (TIA) is similar to what is observed after first-time stroke, according to results of a study published in JAMA Neurology.

Compared with stroke, the effects of TIA on long-term cognitive outcomes are less well understood.

Investigators from The University of Alabama at Birmingham Heersink School of Medicine assessed data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which recruited Black and White adults living in the United States between 2003 and 2007. Study participants (N=16,203) were evaluated for the change in the composite Consortium to Establish a Registry for Alzheimer Disease (CERAD) letter fluency, animal fluency, word list learning, and word list recall scores during a median 14.1-year follow-up on the basis of first-time TIA or stroke.

The individuals with first-time TIA (n=356), first-time stroke (n=965), and control patients (n=14,882) had mean ages of 66.6, 66.8, and 63.2 years; 52.8%, 48.8%, and 56.7% were women; 70.8%, 63.3%, and 63.6% were White; 61.0%, 65.1%, and 53.3% had hypertension; and 20.5%, 25.8%, and 16.6% had diabetes, respectively.

Our findings suggest that TIA was an independent risk factor for cognitive decline, suggesting more aggressive treatment to minimize cognitive risk.

Pre-event cognitive scores were lowest among individuals with stroke (mean, -0.25; 95% CI, -0.32 to -0.17) compared with individuals with TIA (mean, -0.05; 95% CI, -0.02 to -0.07; P =.005) or control patients (mean, 0; 95% CI, -0.03 to 0.03; P <.001) and the yearly decline was -0.04 (95% CI, -0.05 to -0.03), -0.03 (95% CI, -0.05 to -0.01), and -0.02 (95% CI, -0.03 to -0.02), respectively. The rate of cognitive decline differed between individuals with stroke and control patients (P =.001).

At the time of the index event, patients who had stroke had significantly greater cognitive decline (mean, -0.14; 95% CI, -0.21 to -0.07) compared with those who had TIA (mean, 0.01; 95% CI, -0.10 to 0.12; P =.02) or control patients (mean, -0.03; 95% CI, -0.05 to -0.01; P =.003). However, the rate of cognitive decline after the index event was higher among both individuals with stroke (mean, -0.04; 95% CI, -0.05 to -0.03; P =.001) and TIA (mean, -0.05; 95% CI, -0.06 to -0.03; P =.001) relative to control patients (mean, -0.02; 95% CI, -0.02 to -0.02).

Results of a secondary analysis that corrected for additional covariates were consistent with the main findings.

Stratified by the 4 components of the cognitive scores, the post-TIA decline in cognition was primarily driven by deterioration in immediate and delayed auditory-verbal recall.

The major limitation of this study was the use of telephone-delivered cognitive assessments.

The study authors concluded, “…results suggest that the rate of cognitive decline after a first-time, [diffusion-weighted imaging]-negative TIA was similar to the rate of decline observed in individuals after a first-time ischemic stroke…Our findings suggest that TIA was an independent risk factor for cognitive decline, suggesting more aggressive treatment to minimize cognitive risk.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor

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