Functional, Emotional Impairments Likely Following Transient Ischemic Attack

sad older woman
sad older woman
Compared with the general population, people attending transient ischemic attack clinics have functional and emotional deficits.

Compared with the general population, patients who have suffered from a transient ischemic attack (TIA) may experience functional and emotional impairments regardless of their final diagnosis, according to study results published in the International Journal of Stroke.

This prospective controlled observational study was conducted in patients from 30 TIA clinics across 4 regions of England. The study was designed to examine how mood, cognitive, and functional outcomes in patients from a TIA clinic differ from those in the general population in the year following clinic attendance. The investigators sought to describe trajectories of disability and risk for depression and anxiety in patients seen at TIA clinics compared with healthy controls over a 12-month period.

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A total of 1287 participants were included in the study: 364 with a TIA diagnosis, 183 with a diagnosis of minor stroke, 297 with possible TIA, 211 with another condition that mimicked a TIA, and 232 controls who were recruited from primary care providers. All participants completed questionnaires following diagnosis and after 3, 6, and 12 months. Functional ability was measured using the Nottingham Extended Activities of Daily Living (NEADL) Scale and emotional outcomes were measured using the Hospital Anxiety and Depression Scale (HADS-Anxiety and HADS-Depression).

At baseline, all clinic referral groups had significantly worse anxiety scores than controls. Between baseline and 12-month follow-up, there was a statistically significant improvement in anxiety in 3 groups: TIA (HADS-Anxiety score −0.63; P <.003), possible TIA (HADS-Anxiety score −1.11; P <.001), and TIA mimic (HADS-Anxiety score −0.91; P <.001). The control group and patients diagnosed with stroke, however, did not show improvement.

At baseline, the HADS-Depression scores were significantly worse in stroke and possible TIA groups compared with controls but not in the TIA or TIA mimic groups. Between baseline and 12-month follow-up, however, none of the changes in depression scores within groups were as statistically significant and directions of change were mixed across groups.

NEADL scores were lower in clinical groups than controls at baseline, although this was not statistically significant for the TIA mimic group. Over the 12 months of follow-up, NEADL scores improved in the TIA group (1.91; P =.017) and stroke group (3.29; P <.001).

The investigators concluded that the results of this study suggest that sufficient adverse psychological and functional consequences of TIA, minor stroke, and other conditions in patients referred to a TIA clinic have been revealed to warrant further attention and intervention in terms of both clinical rehabilitation and research.


Sackley CM, Mant J, McManus RJ, Humphreys G, Sharp L, Mares K, Savva GM. Functional and emotional outcomes after transient ischemic attack: A 12-month prospective controlled cohort study [published online January 11, 2019]. Int J Stroke. doi:10.1177/1747493018823158