20-Year Study: Mini-Stroke Attacks Raise Long-Term Dementia Risk by Up to 34%
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- Penelitian observasional dalam jurnal Neurology menemukan kaitan antara transient ischemic attack (TIA) dan peningkatan risiko demensia sebesar 34% selama dua dekade.
- Lonjakan risiko terbesar terjadi pada tahun pertama pasca-TIA, mencapai 75%, namun tetap tinggi hingga 20 tahun kemudian.
- Temuan ini mendorong perlunya pemantauan kognitif jangka panjang pada pasien TIA, meski tidak membuktikan hubungan sebab-akibat.
People who have had a transient ischemic attack (TIA), or mini-stroke, face a much higher long-term risk of dementia than those who have never had one. An observational study published in the journal Neurology found that overall dementia risk rose 34% in the TIA group, with risk peaking at 75% in the first year after the attack.
The study, which analyzed 20 years of health data, involved more than 110,000 patients who had a first TIA. The average age of participants was 70, and about half were women. Researchers excluded individuals with a prior history of stroke or dementia. Each TIA patient was matched with one person from the general population with no history of TIA or stroke, and also compared with about 100,000 patients who had a first stroke.
During the monitoring period, 19.3% of TIA participants were diagnosed with dementia, compared with only 15.2% in the comparison group. After accounting for health and demographic factors, the link between TIA and dementia risk remained significant. Notably, in the first year, TIA patients had a 33% lower dementia risk than stroke patients. However, that gap narrowed, and after about five years, both groups received new dementia diagnoses at a similar rate.
The study author, Raed Joundi, MD, DPhil, said the early increase may be partly because TIA patients more often receive follow-up care. "Interestingly, the increased risk does not go away after the initial period, but remains high in the long term," he said. He stressed that a high risk does not mean dementia is certain. "Someone who has a TIA is not destined to develop dementia; most of our participants did not," he added.
Christopher Yi, MD, a vascular surgeon at MemorialCare Orange Coast Medical Center, who was not involved in the study, said the findings broaden how clinicians view TIA. "This study shows that we also need to think about the risk of long-term cognitive decline and dementia," Yi said. Because it is an observational study, Yi cautioned that TIA has not been proven to directly cause dementia. TIA may signal underlying vascular or brain disease that underlies both conditions. Although it does not establish the need for formal cognitive testing, Yi suggested clinicians can set a cognitive baseline and ask patients and families about changes. "TIA should not be ignored just because the symptoms go away," he said.
A limitation of the study is the absence of detailed brain imaging or cognitive tests, so researchers could not identify the type of dementia participants had. However, the findings underscore the importance of long-term cognitive monitoring after TIA, not just prevention of recurrent stroke.
For Indonesia, where the prevalence of stroke and dementia continues to rise as the population ages, these findings are a warning for the health system. With high numbers of people with hypertension and diabetes—major TIA risk factors—screening and education about TIA symptoms need to be strengthened. The public often ignores mini-strokes because the symptoms disappear quickly, even though the risk persists for decades. Doctors in primary care can begin recording the cognitive function of TIA patients as part of routine care.
Going forward, the question is not only how to prevent stroke after TIA, but also how to protect brain health in the long term. Is Indonesia's health system ready to integrate cognitive monitoring into its non-communicable disease control programs?
