Kristin Kramer woke up early on a Tuesday morning 10 years ago because one of her dogs needed to go out. Then, a couple of odd things happened.<\/p>\n
When she tried to call her other dog, \u201cI couldn\u2019t speak,\u201d she said. As she walked downstairs to let them into the yard, \u201cI noticed that my right hand wasn\u2019t working.\u201d<\/p>\n
But she went back to bed, \u201cwhich was totally stupid,\u201d said Kramer, now 54, an office manager in Muncie, Indiana. \u201cIt didn\u2019t register that something major was happening,\u201d especially because, reawakening an hour later, \u201cI was perfectly fine.\u201d<\/p>\n
So she \u201cjust kind of blew it off\u201d and went to work.<\/p>\n
It\u2019s a common response to the neurological symptoms that signal a TIA, a transient ischemic attack or ministroke. At least 240,000 Americans<\/a> experience one each year, with the incidence increasing sharply with age<\/a>.<\/p>\n Because the symptoms disappear quickly, usually within minutes, people don\u2019t seek immediate treatment, putting them at high risk for a bigger stroke.<\/p>\n Kramer felt some arm tingling over the next couple of days and saw her doctor, who found nothing alarming on a CT scan. But then she started \u201cjumbling\u201d her words and finally had a relative drive her to an emergency room.<\/p>\n By then, she could not sign her name. After an MRI, she recalled, \u201cmy doctor came in and said, \u2018You\u2019ve had a small stroke.\u2019\u201d<\/p>\n Did those early-morning aberrations constitute a TIA? Might a 911 call and an earlier start on anticlotting drugs have prevented her stroke? \u201cWe don\u2019t know,\u201d Kramer said. She\u2019s doing well now, but faced with such symptoms again, \u201cI would seek medical attention.\u201d<\/p>\n Now, a large epidemiological study by researchers at the University of Alabama-Birmingham and the University of Cincinnati, published in JAMA Neurology, points to another reason to take TIAs seriously<\/a>: Over five years, study participants\u2019 performance on cognitive tests after a TIA drops as steeply as it does among victims of a full-on stroke.<\/p>\n \u201cIf you have one stroke or one TIA, with no other event over time and no other change in your medical status, the rate of cognitive decline is the same,\u201d said Victor Del Bene, a neuropsychologist and lead author of the study.<\/p>\n An accompanying editorial<\/a> by Eric Smith, a neurologist at the University of Calgary, was pointedly headlined \u201cTransient Ischemic Attack \u2014 Not So Transient After All!\u201d<\/p>\n The study showed that even if the symptoms resolve \u2014 typically within 15 minutes to an hour \u2014 TIAs set people on a different cognitive slope later in life, Smith said in an interview: \u201ca long-lasting change in people\u2019s cognitive ability, possibly leading to dementia.\u201d<\/p>\n The study, analyzing findings from data on more than 30,000 participants, followed three groups of adults age 45 or older with no history of stroke or TIA. \u201cIt\u2019s been a hard group to study because you lack the baseline data of how they were functioning prior to the TIA or stroke,\u201d Del Bene said.<\/p>\n With this longitudinal study, however, researchers could separate those who went on to have a TIA from a group who went on to suffer a stroke and also from an asymptomatic control group. The team adjusted their findings for a host of demographic variables and health conditions.<\/p>\n Immediately after a TIA, \u201cwe don\u2019t see an abrupt change in cognition,\u201d as measured by cognitive tests administered every other year, Del Bene said. The stroke group showed a steep decline, but the TIA and control group participants \u201cwere more or less neck and neck.\u201d<\/p>\n Five years later, the picture was different. People who had experienced TIAs were cognitively better off than those who had suffered strokes. But both groups were experiencing cognitive decline, and at equally steep rates.<\/p>\n After accounting for various possible causes, the researchers concluded that the cognitive drop reflected not demographic factors, chronic illnesses, or normal aging, but the TIA itself.<\/p>\n \u201cIt\u2019s not dementia,\u201d Del Bene said of the decline after a TIA. \u201cIt may not even be mild cognitive impairment. But it\u2019s an altered trajectory.\u201d<\/p>\n Of course, most older adults do have other illnesses and risk factors, like heart disease, diabetes, or smoking. \u201cThese things together work synergistically to increase the risk for cognitive decline and dementia over time,\u201d he said.<\/p>\n The findings reinforce long-standing concerns that people experiencing TIAs don\u2019t respond quickly enough to the incident. \u201cThese events are serious, acute, and dangerous,\u201d said Claiborne Johnston, a neurologist and chief medical officer of Harbor Health in Austin, Texas.<\/p>\n After a TIA, neurologists put the risk of a subsequent stroke within 90 days at 5% to 20%, with half that risk occurring in the first 48 hours.<\/p>\n \u201cFeeling back to normal doesn\u2019t mean you can ignore this, or delay and discuss it with your primary care doctor at your next visit,\u201d Johnston said. The symptoms should prompt a 911 call and an emergency room evaluation.<\/p>\n How to recognize a TIA? Tracy Madsen, an epidemiologist and emergency medicine specialist at the University of Vermont, promotes the BE FAST acronym: balance loss, eyesight changes, facial drooping, arm weakness, speech problems. The \u201cT\u201d is for time, as in don\u2019t waste any.<\/p>\n \u201cWe know a lot more about how to prevent a stroke, as long as people get to a hospital,\u201d said Madsen, vice chair of an American Heart Association committee that, in 2023, revised recommendations<\/a> for TIAs.<\/p>\n The statement called for more comprehensive and aggressive testing and treatment, including imaging, risk assessment, anticlotting and other drugs, and counseling about lifestyle changes that reduce stroke risk.<\/p>\n Unlike other urgent conditions, a TIA may not look dramatic or even be visible; patients themselves have to figure out how to respond.<\/p>\n Karen Howze, 74, a retired lawyer and journalist in Reno, Nevada, didn\u2019t realize that she\u2019d had several TIAs until after a doctor noticed weakness on her right side and ordered an MRI. Years later, she still notices some effect on \u201cmy ability to recall words.\u201d<\/p>\n Perhaps \u201ctransient ischemic attack\u201d is too reassuring a label, Johnston and a co-author argued in a 2022 editorial<\/a> in JAMA. They suggested that giving a TIA a scarier name, like \u201cminor ischemic stroke,\u201d would more likely prompt a 911 call.<\/p>\n The experts interviewed for this column all endorsed the idea of a name that includes the word \u201cstroke.\u201d<\/p>\n Changing medical practice is \u201cfrustratingly slow,\u201d Johnston acknowledged. But whatever the nomenclature, keeping BE FAST in mind could lead to more examples like Wanda Mercer, who shared her experience in a previous column<\/a>.<\/p>\n In 2018, she donated at the bloodmobile outside her office in Austin, where she was a systems administrator for the University of Texas, then walked two blocks to a restaurant for lunch. \u201cWaiting in line, I remember feeling a little lightheaded,\u201d she said. \u201cI woke up on the floor.\u201d<\/p>\n Reviving, she assured the worried restaurant manager that she had merely fainted after giving blood. But the manager had already called an ambulance \u2014 this was smart move No. 1.<\/p>\n The ER doctors ran tests, saw no problems, gave Mercer intravenous fluids, and discharged her. \u201cI began to tell my colleagues, \u2018Guess what happened to me at lunch!\u2019\u201d she recalled. But, she said, she had lost her words: \u201cI couldn\u2019t articulate what I wanted to say.\u201d<\/p>\n Smart move No. 2: Co-workers, suspecting a stroke<\/a>, called the EMTs for the second time. \u201cI was reluctant to go,\u201d Mercer said. \u201cBut they were right.\u201d This time, emergency room doctors diagnosed a minor stroke.<\/p>\n Mercer has had no recurrences. She takes a statin and a baby aspirin daily and sees her primary care doctor annually. Otherwise, at 73, she has retired to an active life of travel, pickleball, running, weightlifting, and book groups.<\/p>\n \u201cI\u2019m very grateful,\u201d she said, \u201cthat I have a happy story to tell.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n