Cognitive Impairment in Transient Ischemic Attack Patients: A Systematic Review

Abstract

Background: Although by definition a transient ischemic attack (TIA) lasts less than 24 h, many patients experience cognitive complaints beyond focal symptom resolution. However, their prevalence, causes and profile are unclear. We therefore performed a systematic review on cognitive impairment after TIA. Summary: Medline and Embase were searched for relevant studies. Risk of bias was assessed, and data synthesis was performed according to the severity of cognitive impairment. Thirteen studies were included, with considerable heterogeneity concerning methods and timing of cognitive testing. Confounding, detection bias and attrition were the main causes of a high risk of bias in several studies. The prevalence of post-TIA mild cognitive impairment ranged from 29 to 68%. Severe cognitive impairment was found in 8-22% of patients. Studies using a cognitive screening instrument and those performed shortly after TIA or several years later, reported the highest frequencies of impairment. Patients evaluated with a screening tool were substantially older than those who underwent a full neuropsychological assessment (weighted mean age difference 10.9 years). Based on limited data, the post-TIA cognitive profile showed prominent executive function deficits. Insufficient data refrained us from drawing conclusions on causality. The few studies that reported neuroimaging results found a minor correlation with cognitive impairment. Key Messages: Mild cognitive impairment is present in more than a third of the TIA patients and has a profile comparable with vascular cognitive impairment. Reported rates of post-TIA cognitive impairment are highly variable and higher frequencies are found with cognitive screening tools. Considerable heterogeneity and insufficient data limit further conclusions about potential causative factors.

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“…Although we use the descriptor “post-stroke”, emerging evidence suggests that transient ischemic attack may also be associated with adverse cognitive prognosis [11]. Using the term PSD in this way does not suggest a particular underlying neuropathological process.…”

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

“…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). Moreover, patients frequently complain of persistent memory problems, confusion, and fatigue (4) that interfere with activities of daily living and reduce quality of life (5).…”

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