Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Neurology. https://doi.org/10.1001/jamaneurol.2024.5082 Dr. Victor A. Del Bene et al.
Points
- The study analyzed cognitive decline after transient ischemic attacks (TIA) using the REGARDS cohort, comparing 356 TIA patients, 965 stroke patients, and 14,882 asymptomatic controls through longitudinal cognitive assessments and neuroimaging.
- Before the index event, stroke patients had significantly lower cognitive scores (mean z score: -0.25) compared to TIA patients (-0.05) and controls (0.0).
- Following the event, stroke patients experienced a significant cognitive decline (-0.14), while TIA patients showed a slight decline (0.01), closer to controls (-0.03).
- TIA patients exhibited a faster annual cognitive decline (-0.05) compared to controls (-0.02), similar to stroke patients (-0.04).
- The study suggests that TIA is associated with long-term cognitive decline, warranting enhanced post-TIA management and cognitive monitoring.
Summary
This study, conducted within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, sought to evaluate whether a transient ischemic attack (TIA) leads to long-term cognitive decline independent of vascular and demographic risk factors. The analysis included 356 individuals with first-time TIAs, 965 individuals with first-time strokes, and 14,882 asymptomatic controls. The study utilized longitudinal cognitive assessments and neuroimaging to compare pre- and post-event cognitive trajectories. The primary outcome was a composite z score based on verbal fluency and memory, with secondary outcomes examining individual test performances.
The results showed that, before the index event, participants with stroke had significantly lower cognitive scores (mean z score: −0.25, 95% CI −0.32 to −0.17) compared to those with TIA (mean z score: −0.05, 95% CI −0.17 to 0.07), and asymptomatic controls (mean z score: 0, 95% CI −0.03 to 0.03). After the index event, stroke patients showed a significant cognitive decline (−0.14, 95% CI −0.21 to −0.07) compared to TIA patients (0.01, 95% CI −0.10 to 0.12) and controls (−0.03, 95% CI −0.05 to −0.01). Additionally, the annual cognitive decline rate was faster in the TIA group (−0.05, 95% CI −0.06 to −0.03) compared to asymptomatic controls (−0.02, 95% CI −0.02 to −0.02), although it was not significantly different from the stroke group (−0.04, 95% CI −0.05 to −0.03).
These findings suggest that TIA, despite the resolution of immediate symptoms, is associated with long-term cognitive decline at a rate similar to that of stroke. The study highlights the need for reconsidering post-TIA management and the importance of regularly screening for cognitive changes. However, further research is needed to understand the underlying mechanisms of this decline.
Link to the article: https://jamanetwork.com/journals/jamaneurology/article-abstract/2830012
References Del Bene, V. A., Howard, G., Gropen, T. I., Lyerly, M. J., Howard, V. J., Sawyer, R. P., & Lazar, R. M. (2025). Cognitive decline after first-time transient ischemic attack. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2024.5082
