It usually lasts a few minutes. Your face droops, an arm goes weak or your words come out scrambled — and then it’s over, and you feel fine.
That’s a transient ischemic attack, or TIA, better known as a mini-stroke. About 240,000 Americans have one every year, according to the American Stroke Association. Because the symptoms vanish, a lot of people shrug it off.
That’s a mistake, and not only for the reason you’ve heard.
Doctors have long known a TIA is a warning that a full-blown stroke may be coming. But a big new study says the larger long-term threat is something most people never connect to it: dementia.
What the study found
Researchers at McMaster University and the Population Health Research Institute in Canada tracked 113,081 people in Ontario who’d had a first TIA and no dementia. Their average age was 70. The findings were published in Neurology, the journal of the American Academy of Neurology.
Over an average of about seven years, 19% of the people who’d had a TIA developed dementia. Among similar people who’d never had a stroke or TIA, it was 15%.
The danger was front-loaded. Dementia risk was 75% higher in the first year after a TIA and 34% higher over the full follow-up. And after a TIA, dementia turned out to be about three times as common as stroke.
Lead author Dr. Raed A. Joundi of McMaster described it as “a large and sustained increase in dementia risk.”
One caveat: A study like this shows a link, not proof that the TIA caused the dementia. The researchers also didn’t have detailed brain scans, so some people may have had hidden brain changes all along.
Still, the lesson for you is practical. What you do after a mini-stroke — especially in that first year — can protect your brain as well as your heart. Here’s where to start.
1. Learn the warning signs that go away
The Centers for Disease Control and Prevention’s shorthand for stroke warning signs is BE FAST:
- Balance: sudden dizziness or loss of balance
- Eyes: sudden trouble seeing
- Face: one side droops
- Arm: one arm drifts down or goes weak
- Speech: slurred or strange speech
- Time: call 911
The trap with a TIA is that the symptoms usually fade within an hour, according to the National Institute of Neurological Disorders and Stroke. It’s tempting to decide you’re fine. You’re not. You just got a warning.
2. Treat it as an emergency, even if you feel fine
Nobody — not you, not your spouse — can tell a TIA from a stroke in the moment. That’s why NINDS says a TIA calls for emergency care right away. Call 911.
The short-term stakes are high, too. Nearly 1 in 5 people with a suspected TIA have a stroke within 90 days, according to the American Stroke Association.
The CDC says more than a third of people who have a TIA and don’t get treated have a major stroke within a year.
Getting checked fast also gets you the tests that tell your doctor what caused the attack and how to head off the next one.
3. Get your blood pressure under control
High blood pressure is a leading cause of stroke, and it’s one of the biggest dementia risk factors you can actually change.
The National Institutes of Health-funded SPRINT MIND study of more than 9,300 people found that aiming for a top number under 120, instead of under 140, appeared to cut the risk of mild cognitive impairment by about 20%. That’s the memory slippage that often comes before dementia.
We’ve covered the blood pressure level experts now recommend to prevent dementia. After a TIA, ask your doctor what your target should be, and buy a home monitor so you know your numbers between visits.
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4. Ask whether your heart is to blame
Atrial fibrillation, or AFib, is an irregular heartbeat that lets blood pool and clot. The CDC says it raises the risk of the most common kind of stroke about fivefold.
It’s tied to your brain, too. An American Heart Association scientific statement found AFib raises the risk of cognitive impairment by 39%.
After a TIA, your doctor may run tests to see whether a heart problem sent a clot to your brain. If you have AFib, blood thinners are a standard treatment, according to the Mayo Clinic. Ask about it, and read up on the heart conditions linked to dementia.
5. Get a memory baseline now
Given what this study found, this may be the most important step. It’s also the one almost nobody takes.
If you’re on Medicare, your yearly wellness visit includes a cognitive assessment to look for signs of dementia, and you pay nothing if your provider accepts assignment. If your doctor suspects a problem, Medicare also covers a more thorough memory visit.
Why bother when you feel sharp? Because a baseline gives your doctor something to compare against later. If something changes, you’ll know sooner, and sooner is when you have the most options.
6. Work on the other risks you can change
The 2024 Lancet Commission on dementia concluded that nearly half of dementia cases could be prevented or delayed by tackling 14 risk factors, according to University College London, which led the work.
Besides high blood pressure, the list includes physical inactivity, diabetes, smoking, heavy drinking, high LDL cholesterol, depression, social isolation and untreated hearing and vision loss.
Hearing loss is one of the biggest single factors. Here are six ways to fix hearing loss, including one for less than $200. And if you have diabetes, the first year after diagnosis may matter for your brain, too.
The bottom line
A mini-stroke is your body sending you a message. Most people hear “stroke” and focus there, as they should.
But this study says the message is bigger than that. Protect your brain, too — and start in the first year, when the risk is highest.
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