Risk of Recurrent Stroke, Other Vascular Events and Dementia after Transient Ischaemic Attack and Stroke

Abstract

The early risk of recurrence after transient ischaemic attack (TIA) or minor stroke is high, ranging from 11% at 7 days in population-based studies, where patients are seen non-urgently, to 3% at 7 days in studies where patients are seen urgently in specialist services. In long-term (up to 10 years) studies of vascular risks after TIA and stroke, the risk of stroke is highest early after the event, and then falls, whereas the risk of coronary events is constant over the follow-up period at around 2% per year. In contrast to the early risk after TIA and stroke, the long-term risks are more dependent on the underlying vascular risk factors than the characteristics of the event itself. Stroke is also associated with an increased risk of dementia. Prevalence of post-stroke dementia varies between studies but is around 28% at 3 months in hospital-based studies where pre-stroke dementia was not excluded and 18% in hospital-based studies excluding pre-stroke dementia. Risk factors for post-stroke dementia include low education, prior or recurrent stroke, and older age. In conclusion, available data suggest that the risk of recurrent vascular events is considerable after TIA and stroke, even in the longer term, and that there is also a high risk of dementia after stroke. However, more studies are required to determine medium- and long-term outcomes in the current era of aggressive secondary preventive therapy.

Persistent Cognitive Impairment After Transient Ischemic Attack

“…[7][8][9][10][11]26 Patient characteristics, definition of cognitive impairment, and delay from TIA to assessment of cognition differ widely between studies. Furthermore, cognitive assessment is mostly limited to screening tools such as Mini-Mental State Examination and Montreal Cognitive Assessment, which are not sensitive to mild cognitive deficits after stroke and do not assess specific cognitive domains.…”

High Prevalence of Peripheral Arterial Disease in Patients with Acute Ischaemic Stroke

“…After acute ischaemic stroke (AIS) or transient ischaemic attack (TIA), available data suggest that the risk of recurrent vascular events is considerable [1]. The long-term prognosis is substantially determined by atherothrombotic events in other arterial beds [2].…”

Symptom Progression or Fluctuation in Transient Ischemic Attack Patients Predicts Subsequent Stroke

“…Transient ischemic attack (TIA), a common subtype of cerebrovascular disease, predicts subsequent vascular events in the near future [1,2,3,4,5,6,7,8,9,10]. Several studies have demonstrated that the duration of an attack, the presence of symptoms upon hospital arrival, neuroimaging results, and the presence of vascular diseases are factors that indicate early stroke in TIA patients [1,2,3,4].…”