Hospitalized transient ischemic attack was linked to higher long-term risks of dementia, stroke, cardiovascular disease, and death in a multidecade community study.
Among 13,721 patients followed for nearly 30 years, those with a hospitalized transient ischemic attack (TIA) had nearly twice the risk of developing dementia compared with patients without TIA. The median time from TIA to dementia diagnosis was more than 7 years. Stroke and ischemic stroke occurred at much higher rates, while cardiovascular disease (CVD) and death from cardiovascular causes were also elevated. Overall all-cause mortality was 55% higher following TIA. Sensitivity analyses showed that dementia risk remained even when excluding patients who later experienced stroke.
The study used the Atherosclerosis Risk in Communities cohort, which enrolled 15,792 patients aged 45 to 64 years from 4 U.S. communities in 1987 to 1989. For this analysis, researchers excluded those with prior stroke, TIA, heart disease, or dementia, leaving 13,721 patients. Participants were followed through clinic visits, phone calls, hospital records, and death registries until 2020. Hospitalized TIA was identified using discharge codes, and dementia outcomes were determined through cognitive testing, medical records, and registry data. Models adjusted for demographics, education, smoking, hypertension, diabetes, cholesterol, medication use, and APOE ε4 genotype.
The study had limitations. TIAs were identified through hospital discharge codes, which may have missed milder or outpatient cases. Baseline risk factors were measured at enrollment rather than at the time of TIA, which may not reflect health status at onset. Imaging technology available in the earlier years of the study may have missed small infarcts. Because the population came from only 4 U.S. communities, the findings may not be generalizable.
Hospitalized TIA was consistently associated with increased risks of dementia, stroke, CVD, and mortality in long-term follow-up. Researchers noted that while clinical guidelines address acute management and vascular risk reduction, there are no standard recommendations for routine cognitive screening following TIA.
“The clinical implication of our results and other studies of post-TIA cognitive decline and dementia is that cognitive screening during follow-up may be informative and patient and family counseling on this aspect of post-TIA outcomes could be helpful in care planning,” said Kamakshi Lakshminarayan, MD, PhD, Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, and colleagues.
Full disclosures can be found in the study.
Source: Neurology
