Transient Ischemic Attack and Cognitive Impairment: A Review.
Transient ischemic attack (TIA) is a neurologic deficit resulting from focal ischemia in the brain, spinal cord, or retina. Historically, the definition included symptom resolution within 24 hours. However, recent studies investigating cognition after TIA suggest that deficits in executive function persist at 7 days post-TIA, although few studies have examined these effects long term. Recent advances in neuroimaging techniques provide emerging evidence of permanent microvascular tissue damage in the brain, suggesting that the effects of TIA may persist beyond resolution of focal symptoms. A further challenge is that there is debate concerning the clinical definition of TIA and the use of diagnostic neuroimaging studies and standardization of neuropsychological tests used to evaluate cognitive deficits in this population. Subtle changes in memory, attention, and problem-solving abilities may negatively influence an individual's ability to adopt positive health behaviors. Despite advances in the field, more research is needed; hence, the purpose of this article is to provide an overview of clinical factors for clinicians and researchers to consider when investigating cognitive deficits among post-TIA populations. Definitions of TIA are reviewed, and the importance of neuropsychological evaluation and neuroimaging correlates of TIA in establishing a positive diagnosis will be discussed. Nurses especially in advanced practice roles are uniquely positioned to assess and implement treatments in at-risk groups and therefore should be knowledgeable about these possible cognitive effects.
Questions or comments about this article may be directed to Christine A. Ganzer, PhD PMHNP, at Anne.Ganzer@gmail.com. She is an Assistant Professor, Hunter-Bellevue School of Nursing, Hunter College, New York, NY. Andrea Barnes, PhD ARNP-BC, is Nurse Practitioner, Primary Care, VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, NY. Constance Uphold, PhD ARNP-BC FAAN, is Associate Director for Implementation and Outcomes Research, Geriatric Research Education and Clinical Center and Extended Care and Research Services, North Florida/South Georgia Veterans Health System; and Associate Professor, Department of Aging & Geriatric Research, University of Florida, Gainesville, FL. Alan R. Jacobs, MD, is Clinician, Private Practice, New York, NY.
Christine A
CA
Ganzer
Andrea
A
Barnes
Constance
C
Uphold
Alan R
AR
Jacobs
D001921:Brain / Q000503:physiopathology; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D059906:Neuroimaging; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D065816:Neuroscience Nursing