Cognitive performance in Mongolian patients after transient ischemic attack and the impact of vascular risk factors: a case-controlled study

Authors

  • Delgermaa Tsagaankhuu (1) Department of Neurology, Mongolian National University of Medical Sciences, Ulaanbaatar 13270, Mongolia. (2) Department of Neurology, Mongolia-Japan Hospital, Ulaanbaatar 13000, Mongolia.
  • Altanshagai Enkhtaivan Department of Neurology, Mongolian National University of Medical Sciences, Ulaanbaatar 13270, Mongolia.
  • Tsagaankhuu Guntev Department of Neurology, Mongolian National University of Medical Sciences, Ulaanbaatar 13270, Mongolia.

DOI:

https://doi.org/10.31117/neuroscirn.v7i3.336

Keywords:

Cognition, Ischemic attack, Vascular risk factor

Abstract

Cognitive impairment is a prevalent occurrence after a transient ischemic attack (TIA), but there is currently insufficient evidence to understand the impact of vascular risk factors (VRFs) on this event. We aimed to determine the occurrence of cognitive impairment following a TIA and to explore whether VRFs correlate with cognitive impairment. This hospital-based case-controlled study recruited patients with TIA aged 45 to 65 years without prior stroke or cognitive decline who underwent the Mini Mental State Examination (MMSE) within 3 months at the Mongolia-Japan Hospital between May and December 2023. Age (±1 year) and sex-matched controls were selected from outpatient departments. One hundred thirty-four patients (N=134) with TIA (61.2% women, mean age, 56.4±6.5 years) were included and compared with 134 controls (61.2% women, mean age, 56.1±6.4 years). Significant differences in MMSE scores were noted between the study groups, with mean scores of 26.32±2.23 for TIA patients and 27.99±1.94 for non-TIA subjects (p<0.0001). In the crude model, the presence of hypertension, a family history of myocardial infarction, hypercholesterinaemia, atrial fibrillation, and having three or more VRFs were all significantly associated with global cognitive performance on the MMSE (all p<0.05). When age, gender and education are controlled for, performance on the MMSE is uniquely accounted for by the presence of atrial fibrillation and having three or more VRFs (all p<0.05). Our results suggest that global cognitive impairment following a TIA may be linked to the number of VRFs in these individuals. This emphasises the importance of sustained management of VRFs beyond the recovery period to mitigate the risk of cognitive impairment.

References

Aam, S., Gynnild, M. N., Munthe-Kaas, R., Saltvedt, I., Lydersen, S., Knapskog, A. B., Ihle-Hansen, H., Ellekjær, H., Eldholm, R. S., & Fure, B. (2021). The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study. Frontiers in Neurology, 12, 678794. https://doi.org/10.3389/fneur.2021.678794

Clarey, J., Lasserson, D., Levi, C., Parsonsd, M., Dewey, H., Alan Barber, P., Quain, D., McElduff, P., Sales, M., & Magin, P. (2014). Absolute cardiovascular risk and GP decision making in TIA and minor stroke. Family Practice, 31(6), 664–669. https://doi.org/10.1093/fampra/cmu054

Easton, J. D., Saver, J. L., Albers, G. W., Alberts, M. J., Chaturvedi, S., Feldmann, E., Hatsukami, T. S., Higashida, R. T., Johnston, S. C., Kidwell, C. S., Lutsep, H. L., Miller, E., & Sacco, R. L. (2009). Definition and evaluation of transient ischemic attack: A scientific statement for healthcare professionals from the American heart association/American stroke association stroke council; council on cardiovascular surgery and anesthesia; council on cardiovascular radiology and intervention; council on cardiovascular nursing; and the interdisciplinary council on peripheral vascular disease. Stroke, 40(6), 2276–2293. https://doi.org/10.1161/STROKEAHA.108.192218

Faraco, G., & Iadecola, C. (2013). Hypertension: A harbinger of stroke and dementia. Hypertension, 62(5), 810–817. https://doi.org/10.1161/HYPERTENSIONAHA.113.01063

Fens, M., Van Heugten, C. M., Beusmans, G. H. M. I., Limburg, M., Haeren, R., Kaemingk, A., & Metsemakers, J. F. M. (2013). Not as transient: Patients with transient ischaemic attack or minor stroke experience cognitive and communication problems; An exploratory study. European Journal of General Practice, 19(1), 11–16. https://doi.org/10.3109/13814788.2012.715147

Folstein, M. F., Folstein, S. E., & Mchugh, P. R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6

Ganesh, A., & Barber, P. A. (2022). The Cognitive Sequelae of Transient Ischemic Attacks—Recent Insights and Future Directions. Journal of Clinical Medicine, 11(9), 2637. https://doi.org/10.3390/jcm11092637

Goette, A., & Braun-Dullaeus, R. C. (2008). Atrial fibrillation is associated with impaired cognitive function and hippocampal atrophy: Silent cerebral ischaemia vs. Alzheimer's disease? European Heart Journal, 29(17), 2067–2069. https://doi.org/10.1093/eurheartj/ehn343

Guyomard, V., Metcalf, A. K., Naguib, M. F., Fulcher, R. A., Potter, J. F., & Myint, P. K. (2011). Transient ischaemic attack, vascular risk factors and cognitive impairment: A case-controlled study. Age and Ageing, 40(5), 641–644. https://doi.org/10.1093/ageing/afr079

Hammant, A., Chithiramohan, T., Haunton, V., & Beishon, L. (2023). Cognitive testing following transient ischaemic attack: A systematic review of clinical assessment tools. Cogent Psychology, 10(1), 2196005. https://doi.org/10.1080/23311908.2023.2196005

Jolly, T. A. D., Bateman, G. A., Levi, C. R., Parsons, M. W., Michie, P. T., & Karayanidis, F. (2013). Early detection of microstructural white matter changes associated with arterial pulsatility. Frontiers in Human Neuroscience, 7, 782. https://doi.org/10.3389/fnhum.2013.00782

Munir, M., Ursenbach, J., Reid, M., Sah, R. G., Wang, M., Sitaram, A., Aftab, A., Tariq, S., Zamboni, G., Griffanti, L., Smith, E. E., Frayne, R., Sajobi, T. T., Coutts, S. B., D’Esterre, C. D., & Barber, P. A. (2019). Longitudinal brain atrophy rates in transient ischemic attack and minor ischemic stroke patients and cognitive profiles. Frontiers in Neurology, 10, 18. https://doi.org/10.3389/fneur.2019.00018

Munkhsukh, M. U., Namjil, D., Byambajav, P., Angarag, E. A., Junai, S., Dagvajantsan, B., & Byambasukh, O. (2021). Dementia risk among mongolian population with type 2 diabetes: A matched case-control study. NeuroSignals, 20(3), 659–666. https://doi.org/10.31083/j.jin2003070

Pendlebury, S. T., Cuthbertson, F. C., Welch, S. J. V., Mehta, Z., & Rothwell, P. M. (2010). Underestimation of cognitive impairment by mini-mental state examination versus the montreal cognitive assessment in patients with transient ischemic attack and stroke: A population-based study. Stroke, 41(6), 1290–1293. https://doi.org/10.1161/STROKEAHA.110.579888

Pendlebury, S. T., Wadling, S., Silver, L. E., Mehta, Z., & Rothwell, P. M. (2011). Transient Cognitive Impairment in TIA and Minor Stroke. Stroke, 42, 11. https://doi.org/10.1161/strokeaha.111.621490

Rao, R., Jackson, S., & Howard, R. (1999). Neuropsychological Impairment in Stroke, Carotid Stenosis, and Peripheral Vascular Disease A Comparison with Healthy Community Residents. Stroke, 30(10), 2167–2173 https://doi.org/10.1161/01.str.30.10.2167

Rowley, H. A. (2013). The alphabet of imaging in acute stroke does it spell improved selection and outcome? Stroke, 44(SUPPL. 1), S53–S54. https://doi.org/10.1161/strokeaha.113.001939

Special Report from the National Institute of Neurological Disorders and Stroke Classification of Cerebrovascular Diseases III. (1990). Stroke, 21, 4. https://doi.org/10.1161/01.STR.21.4.637

Triantafyllidi, H., Arvaniti, C., Lekakis, J., Ikonomidis, I., Siafakas, N., Tzortzis, S., Trivilou, P., Zerva, L., Stamboulis, E., & Kremastinos, D. T. (2009). Cognitive impairment is related to increased arterial stiffness and microvascular damage in patients with never-treated essential hypertension. American Journal of Hypertension, 22(5), 525–530. https://doi.org/10.1038/ajh.2009.35

Turner, G. M., Calvert, M., Feltham, M. G., Ryan, R., & Marshall, T. (2016). Ongoing impairments following transient ischaemic attack: retrospective cohort study. European Journal of Neurology, 23(11), 1642–1650. https://doi.org/10.1111/ene.13088

Van Rooij, F. G., Kessels, R. P. C., Richard, E., De Leeuw, F. E., & Van Dijk, E. J. (2016). Cognitive Impairment in Transient Ischemic Attack Patients: A Systematic Review. Cerebrovascular Diseases, 42(1–2), 1–9. https://doi.org/10.1159/000444282

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Published

2024-09-04

How to Cite

Tsagaankhuu, D., Enkhtaivan, A. and Guntev, T. (2024) “Cognitive performance in Mongolian patients after transient ischemic attack and the impact of vascular risk factors: a case-controlled study”, Neuroscience Research Notes, 7(3), pp. 336.1–336.8. doi: 10.31117/neuroscirn.v7i3.336.

Issue

Vol. 7 No. 3 (2024): Regular Issue

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Research Notes

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Copyright (c) 2024 Delgermaa Tsagaankhuu, Altanshagai Enkhtaivan, Tsagaankhuu Guntev

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