Transient Global Amnesia (TGA): Younger Age and Absence of Cerebral Microangiopathy Are Potentially Predisposing Factors for TGA Recurrence

Abstract

Background: Transient global amnesia (TGA) is defined by an acute memory disturbance of unclear etiology for a period of less than 24 h. TGA occurs as a single event in most cases. Prevalence rates of recurrent TGA vary widely from 5.4 to 27.1%. This retrospective study aimed to determine predictors for TGA recurrence.Methods: Cardiovascular risk profile and magnetic resonance imaging (MRI) of 340 hospitalized TGA patients between 2011 and 2020 were retrospectively analyzed. The median follow-up period amounted to 4.5 ± 2.7 years. Comparisons were made between TGA patients with and without subsequent recurrence.Results: TGA patients with subsequent recurrence were significantly younger (recurrent vs. single episode, 63.6 ± 8.6 years vs. 67.3 ± 10.5 years, p = 0.032) and showed a lower degree of cerebral microangiopathy compared to TGA patients without recurrence. The mean latency to recurrence was 3.0 years ± 2.1 years after the first episode. In a subgroup analysis, patients with at least five years of follow-up (N = 160, median follow-up period 7.0 ± 1.4 years) had a recurrence rate of 11.3%. A 24.5% risk of subsequent TGA recurrence in the following five years was determined for TGA patients up to 70 years of age without microangiopathic changes on MRI (Fazekas' score 0).Conclusion: Younger TGA patients without significant microangiopathy do have an increased recurrence risk. In turn, pre-existing cerebrovascular pathology, in the form of chronic hypertension and cerebral microangiopathy, seems to counteract TGA recurrence.

Transient Global Amnesia (TGA): Sex-Specific Differences in Blood Pressure and Cerebral Microangiopathy in Patients with TGA

“…Patients who did not meet the diagnostic criteria were not included in the study. This investigation represents an extension of the cohort from previously reported studies [ 6 , 21 ]. All patients having a discharge diagnosis of TGA during the relevant period were included.…”

“…The aim of the present study was to analyse sex-specific differences of TGA patients in a large retrospective cohort of a tertiary referral centre. In previous studies, we were able to show differences between TGA patients and acute stroke patients as well as differences between TGA patients with and without subsequent recurrence [ 6 , 21 ]. It was shown that TGA patients, regardless of sex, had significantly higher blood pressure values on admission compared to acute stroke patients, but were less likely to present with signs of chronic hypertension [ 21 ].…”

“…This neuropsychological syndrome is thought to be caused by a transient disturbance in hippocampal function [ 2 , 3 ]. In addition, it reflects a reversible disruption of the functional connectivity of the broader episodic memory network, including the medial temporal sub-network, as well as the orbitofrontal-cingulate, inferior temporal, medial occipital, and deep-structure sub-networks [ 4 , 5 , 6 ].…”

“…It was shown that TGA patients, regardless of sex, had significantly higher blood pressure values on admission compared to acute stroke patients, but were less likely to present with signs of chronic hypertension [ 21 ]. Furthermore, the risk of TGA recurrence was lower in younger patients and in cases with an absence of cerebral microangiopathy [ 6 ], which is a common cerebral manifestation of chronic hypertension.…”

Forgetting the Unforgettable: Transient Global Amnesia Part II: A Clinical Road Map

“…However, there was only a weak relationship between recurrence and a family history of dementia and a personal history of head injury [ 128 ]. In a recent study of 340 German TGA patients with a follow-up of at least five years, patients with TGA recurrence were significantly younger and had less extent of cerebral microangiopathy than patients with isolated TGA episodes [ 129 ]. Specifically, patients up to 70 years of age without microangiopathic changes on MRI (Fazekas’ score 0) had a 24.5% risk of subsequent TGA recurrence over the next five years [ 129 ].…”