The Cognitive Sequelae of Transient Ischemic Attacks—Recent Insights and Future Directions

Abstract

There is now considerable evidence that Transient Ischemic Attack (TIA) carries important sequelae beyond the risk of recurrent stroke, particularly with respect to peri-event and post-event cognitive dysfunction and subsequent cognitive decline. The occurrence of a TIA could provide an important window in understanding the relationship of early mixed vascular-neurodegenerative cognitive decline, and by virtue of their clinical relevance as a “warning” event, TIAs could also furnish the opportunity to act preventatively not only for stroke prevention but also for dementia prevention. In this review, we discuss the current state of the literature regarding the cognitive sequelae associated with TIA, reviewing important challenges in the field. In particular, we discuss definitional and methodological challenges in the study of TIA-related cognitive impairment, confounding factors in the cognitive evaluation of these patients, and provide an overview of the evidence on both transient and long-term cognitive impairment after TIA. We compile recent insights from clinical studies regarding the predictors and mediators of cognitive decline in these patients and highlight important future directions for work in this area.

Impact of Serum Cystatin C Level on Long-Term Cognitive Impairment After Acute Ischemic Stroke and Transient Ischemic Attack

“… 1 There are both transient and long-term cognitive impairment after TIA. 2 This TCI (rather than the absolute cognitive level) predicted subsequent cognitive decline. Approximately 58.82% of patients experienced cognitive impairment after stroke in acute phase.…”

Arterial spin labelling reveals multi-regional cerebral hypoperfusion in patients with transient ischemic attack that are unrelated to ischemia location: A proof-of-concept study

“…It is now generally accepted that a significant contributor to the failure of therapeutic treatments is that the diagnosis can only be reliably established late in the disease course, when neuronal loss and neurosynaptic degeneration have taken hold, and years after irreversible damage to the brain has occurred. It is also appreciated, that stroke, including transient ischemic attack (TIA), is a distinct and important risk factor for dementia, doubling the risk of later cognitive decline independently of known vascular and lifestyle risk factors [ 2 , 3 ]. Therefore, the best future strategy appears to consist of early intervention in the preclinical phase, at a time when the brain is only minimally affected.…”

Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations

“…A nebulous area also exists around the underlying processes that link vascular risk factors, such as diabetes or atrial fibrillation, with the ensuing risk of dementia. Additionally, the potential malleability of this risk based on intensified control of these risk factors or stroke preventive measures remains a question [351].…”

“…Historically, research studies have relied on community members who willingly participated in their experiments as control groups. Yet, this practice begs the question of the representativeness of such volunteers, particularly concerning their vascular and TIA risks or historical health profiles, and the potential predisposition towards cognitive decline [351].…”

“…A case in point is the UK's PREVENT cohort, which is strategically enrolling participants spanning high, medium, and low susceptibility brackets for late-onset Alzheimer's disease. Striking a harmonious balance remains a challenge: researchers must weigh the merits of a large, encompassing population-based research design against a more targeted population that allows for a deeper dive into individual assessments and phenotypic elucidations [351].…”