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Background: Transient ischemic attack (TIA) has drawn increased interest in the last 20 years concerning sequalae. However, the longterm consequences and rehabilitation needs of TIA remain largely unknown. The overall aims of this thesis were to evaluate long-term disabilities after TIA and their effects on patients’ daily activities, social participation, and health-related quality of life (HRQoL). 

Methods: This thesis involved two cohorts from two different observational studies. The first cohort included 47 community-dwelling individuals in the sub-acute phase (4 months) after TIA who were included in a prospective cohort study (Study I). The second cohort was from a retrospective cohort study (Studies II–IV) assessing 431 community-dwelling adults’ rehabilitation needs, mainly in the chronic phase (1–13 years) after TIA onset. Patient comorbidities, such as hypertension and atrial fibrillation, were collected from the Riksstroke Registry in Study I and patients’ medical records in Studies II–IV. The multidimensional consequences of TIA and rehabilitation needs after TIA were assessed by five well-validated patient-reported outcome measures (PROMS), including the Fatigue Assessment Scale with added sleep-related questions, Hospital Anxiety Depression scale, simplified Modified Rankin Scale, Stroke Impact Scale 3.0 (SIS), and the EQ-5D three-level version (EQ-5D-3L). Statistical analyses were performed using SPSS v.27 and GraphPad Prism 10. 

Results: Assessments with PROMS were feasible among community-dwelling persons after a first-ever TIA in an outpatient setting (Study I). At the sub-acute stage, the most common parameter affected was mood (reported by 89% of participants), followed by bladder function (70%), sexual life (52%), strength (51%), and fatigue (26%). Symptoms of depression and anxiety were reported by 6% and 17% of participants, respectively. In Study II, long-term patient-reported fatigue was evident among 37.8% of the community-dwelling adults from 6 months up to 13 years following a TIA. Among first-ever TIA patients, 35% were fatigued, with higher mean scores than the general age-matched population. Additionally, depression, anxiety, heart disease, and atrial fibrillation were independently associated with increased perceived fatigue in the same group. This elevated perceived fatigue was significantly associated with fewer activities in everyday life. 

In Study III, the most reported perceived disabilities assessed by the SIS belonged to the emotions (80.6 SD 15.5), strength (84.2 SD 24.0), and participation (89.1 SD 18.5) domains up to the 10-year follow-up. No significant differences in SIS domains were observed over time when comparing data between the three groups (i.e. < 1 year post-TIA; 1 - 5 years post-TIA; and 5 – 10 years post-TIA). Perceived disabilities and their correlations with Activities of Daily Living / instrumental Activities of Daily Living ADL/IADL and participation were demonstrated consistently up to 10 years after TIA. 

In Study IV, we demonstrated that most first-ever TIA patients were not affected regarding HRQoL (mean 0.88 SD 0.2) as measured by index scores of the EQ-5D-3L. However, the index scores were significantly lower in the TIA with stroke group (0.77 (0.3); p < 0.001) compared to the first-ever TIA group. A preserved HRQoL was observed at a similar level from 1 to more than 10 years after the first-ever TIA (p = 0.643). The most reported sub-domain problem was pain, followed by depression/anxiety and mobility. Factors associated significantly with poorer HRQoL in this cohort (p < 0.001) were persons with recurrent TIA and stroke (odds ratio (95% CI) 0.67 (0.53–0.83)), more depression (0.59 (0.53–0.66)), anxiety (0.73 (0.68–0.79)), and perceived fatigue (0.81 (0.77-0.85)). 

Conclusion: Our findings support the screening of long-term consequences of TIA among community-dwelling individuals. Besides secondary prevention measures after TIA, tailored rehabilitation interventions could improve the everyday lives of TIA patients.