A population survey of symptoms suggestive of transient ischemic attacks

Transient neurological symptoms in the older population: report of a prospective cohort study--the Medical Research Council Cognitive Function and Ageing Study (CFAS)

OBJECTIVE

Transient ischaemic attack (TIA) is a recognised risk factor for stroke in the older population requiring timely assessment and treatment by a specialist. The need for such TIA services is driven by the epidemiology of transient neurological symptoms, which may not be caused by TIA. We report prevalence and incidence of transient neurological symptoms in a large UK cohort study of older people.

DESIGN

Longitudinal cohort study

SETTING

The Medical Research Council Cognitive Function and Aging Study (CFAS) is a population representative study based on six centres across England and Wales.

PARTICIPANTS

Random samples of people in their 65th year were obtained from Family Health Service Authority lists. The participation rate was 80% (n=13 004). Interview at baseline included questions about stroke and three transient neurological symptoms, repeated in a subsample after 2 years. Patients were flagged for mortality.

MAIN OUTCOME MEASURES

Prevalence and 2-year incidence of transient neurological symptoms.

RESULTS

In 11 903 participants without a history of stroke, 271 (2.3%) reported transient problems with speech, 872 (7.6%) with sight and 596 (5.1%) weakness in a limb with 1456 (12.7%) reporting at least one symptom. Of those reinterviewed (n=6748), 675 (9.8%) reported at least one symptom over 2 years.

CONCLUSIONS

Lifetime prevalence and incidence of transient neurological symptoms in people aged 65 years and over is high and is substantially greater than the incidence of TIA in hospital-based and population-based studies. These high rates of transient neurological symptoms in the community in the older population should be considered when planning TIA services.

Frequency and distribution of long-term ECG-recorded cardiac arrhythmias in an elderly population. With special reference to neurological symptoms

The prevalence of serious episodic cardiac arrhythmias known to correlate with cerebral symptoms was investigated in 103 elderly, randomly selected persons with the aid of 22 hours of long-term ECG recording (LTER). Twelve of 26 subjects with dizziness/syncope had serious episodic arrhythmias compared with 5 of 77 subjects without these symptoms. This difference is significant (p less than 0.001). Five patients fulfilled strict criteria for pacemaker treatment of symptomatic bradycardias. Three had the sick sinus syndrome and two had third degree atrioventricular block. In 4 subjects, drugs were withdrawn due to bradycardia; and 4 were treated for tachyarrhythmias. Despite the finding of minor arrhythmnias in almost all asymptomatic subjects, it is concluded that serious episodic arrhythmias in the elderly are related to cerebral symptoms. It is also concluded that these arrhythmias are more common than previously believed and that LTER should be widely used.

Prevalence of chronic disease and health practices in a retirement community

The prevalence of chronic disease based on a mailed questionnaire was estimated as part of a continuing epidemiological study of a retirement community. The prevalence of eight chronic diseases (high blood pressure, angina, myocardial infarction, stroke, diabetes, rheumatoid arthritis, glaucoma, and cancer) was determined across all age and sex groups. The relationships between these diseases and several health related life-style practices were assessed. A health index summarizing five practices (smoking, alcohol consumption, exercise, sleep and obesity) was clearly related to the prevalence of disease.

Unexpected trends in the analysis of a questionnaire and interview procedure to detect transient cerebral ischemic attack in a female population

By means of a case-control study, social and biomedical factors were considered in relation to transient cerebral ischemic attack occurrence as determined by questionnaire and interview among a population of females ( greater than 50 years of age) residing in the city of utrecht and surroundings. Contrary to earlier expectations, a greater TIA risk was found associated with: lower systolic and diastolic blood pressure, a low-salt diet for high blood pressure, lower body weight, smaller body surface, and use of medicines for cardiac insufficiency/arrhythmias and chronic anxiety. The importance of hemodynamic processes (i.e. hypotensive episodes of cerebral circulation) for TIA within the general population is emphasized.

Use of a self-administered questionnaire for detection of transient cerebral ischemic attacks: I. Survey of elderly persons living in retirement facilities

A self-administered questionnaire designed to identify people with transient cerebral ischemia (TIA) in large population groups was distributed to approximately 10,000 elderly persons living in public and private retirement facilities in the United States. The population resided in eight cities, and 74% completed the survey. Transient focal neurological symptoms compatible with a diagnosis of TIA within the previous year were reported by 6.4% of the respondents. Uncertain manifestations of TIA, i.e., dizziness, light-headedness, or loss of balance, were noted by an additional 15.4%; the remaining 78.2% had no manifestations of this disorder. A clinical history for TIA was taken by a neurologist in a sample of 1,712 respondents to determine the validity of the questionnaire responses. Thirty (7.1%) of 423 persons presumed by the questionnaire to have TIA met the standard clinical criteria for the diagnosis. An additional 8 cases of TIA were found by the neurologist among the 1,289 interviewed persons presumed by the questionnaire to have uncertain TIA or no evidence of the disorder. The twelve-month period prevalence of TIA was estimated to be 8.2 per 1,000 in the total respondent population and 5.8 per 1,000 among those without a history of prior completed stroke. Despite the high proportion of false-positive neurological symptoms of TIA elicited by the questionnaire, this survey instrument nevertheless screened out for further study the 6% of the population in whom 55% of the TIAs occurred.