“This suggests that in people who have a TIA — which is generally thought to not cause any lasting damage in the brain — cognitive decline clearly occurs at the same rate as in a person who has had a stroke, which causes damage clearly identified on imaging,” says Cheryl Bushnell, MD, a professor of neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina. Dr. Bushnell, who is also a neurologist at Atrium Health Wake Forest Baptist, wasn’t involved in the study.
Mini-Stroke Causes a Temporary Lack of Blood Flow to the Brain
A transient ischemic attack is considered a “temporary” stroke because it means there is a short-lived lack of blood flow to part of the brain. Without blood flow, brain cells can’t function and start to die.
Mini-Stroke More Likely to Affect Memory Than Verbal Skills
To find out if TIA is a risk factor for cognitive decline, researchers from the University of Alabama at Birmingham used data from more than 16,000 people enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. To enroll, people had to be at least 45 years old and never have experienced a TIA or stroke. Participants had an average age of 64, and about two-thirds were white and one-third Black.
Scientists followed people in the study for an average of 14 years, comparing the cognitive changes over time in three groups: Those who had a first-time TIA, those who had a first-time stroke, and a control group of people who didn’t have either.
Researchers used brain imaging to confirm whether participants had TIA or stroke, and they assessed cognitive function through a computer-assisted telephone interview.
Key findings:
- People with a first-time stroke showed significant cognitive decline immediately afterward, which worsened over time.
- People with a TIA showed a slower but notable decline in cognitive performance compared with those with no stroke or no TIA.
- The cognitive decline for people with a TIA was not immediate but happened gradually, with an annual rate of cognitive decline similar to that seen in people who had a stroke.
- The cognitive decline for those with a TIA was significantly faster than for the control group, although not quite as rapid as for those who had a stroke.
The declines in people with TIA were “largely driven by immediate and delayed memory recall declines,” the scientists said, rather than changes in verbal fluency.
The results indicate that TIA is an independent risk factor for cognitive decline, and that more aggressive treatment is needed to minimize cognitive risk, the authors concluded.
This study provides additional evidence that TIA is not a harmless event, says Marco Gonzalez, MD, a neurologist at Cleveland Clinic in Ohio, who was not involved in the research.
“A large percentage of cerebrovascular events such as TIA are the end result of uncontrolled risk factors for an extended period of time, and should not be taken lightly. This study confirms that TIA survivors should be treated aggressively to prevent long-term complications such as cognitive decline,” says Dr. Gonzalez.
What Are the Risk Factors for a Mini-Stroke?
- Being 40 years or older
- Heart and blood vessel disease, such as atrial fibrillation (afib)
- High blood pressure
- Smoking
- Diabetes
- High cholesterol levels
- Illegal drug use or heavy alcohol use
- Recent childbirth
- Previous history of TIA or stroke
- Too much sitting and not enough physical activity
- A BMI of 30 or higher
- Current or past history of blood clots
“Most TIAs and strokes are preventable,” says Gonzalez. “People should check their blood pressure regularly to make sure it is controlled. Annual physicals are a great opportunity to prevent TIA and stroke.”
Symptoms of Mini-Stroke
- One-sided weakness or paralysis (hemiplegia)
- Difficulty with or loss of speaking ability (aphasia)
- Slurred or garbled speech
- Loss of muscle control on one side of the face or facial droop
- Sudden loss of one or more senses
- Blurred or double vision
- Loss of coordination, clumsiness
- Dizziness or vertigo
- Nausea and vomiting
- Stiff neck
- Emotional instability and personality changes
- Confusion or agitation
- Memory loss
- Headaches that are very sudden and severe
- Passing out or fainting
What Should You Do if You’ve Already Had a Mini-Stroke?
“For people who have a clear diagnosis of a TIA from a stroke specialist, addressing and managing risk factors is of the utmost importance,” says Bushnell.
She offers the following tips:
- Keep blood pressure less than 130/80 millimeters of mercury (mmHg).
- If you have type 2 diabetes, make sure your blood sugar is under control.
- Keep LDL cholesterol to less than 70 milligrams per deciliter (mg/dL).
- Stop smoking.
- Increase your physical activity.
- Maintain a healthy weight.
- Follow a Mediterranean diet.
- Prioritize good sleep.
“These can all help to protect the brain from further TIA, stroke, and dementia,” Bushnell says.