Risk of recurrent stroke, other vascular events and dementia after transient ischaemic attack and stroke.
Pendlebury ST., Rothwell PM.
The early risk of recurrence after transient ischaemic attack (TIA) or minor stroke is high, ranging from 11% at 7 days in population-based studies, where patients are seen non-urgently, to 3% at 7 days in studies where patients are seen urgently in specialist services. In long-term (up to 10 years) studies of vascular risks after TIA and stroke, the risk of stroke is highest early after the event, and then falls, whereas the risk of coronary events is constant over the follow-up period at around 2% per year. In contrast to the early risk after TIA and stroke, the long-term risks are more dependent on the underlying vascular risk factors than the characteristics of the event itself. Stroke is also associated with an increased risk of dementia. Prevalence of post-stroke dementia varies between studies but is around 28% at 3 months in hospital-based studies where pre-stroke dementia was not excluded and 18% in hospital-based studies excluding pre-stroke dementia. Risk factors for post-stroke dementia include low education, prior or recurrent stroke, and older age. In conclusion, available data suggest that the risk of recurrent vascular events is considerable after TIA and stroke, even in the longer term, and that there is also a high risk of dementia after stroke. However, more studies are required to determine medium- and long-term outcomes in the current era of aggressive secondary preventive therapy.