What Should I Ask a Client with a History of a TIA?
Causes | Risk Factors | Symptoms | Screening Questionnaire

What is a transient ischemic attack or TIA?

A transient ischemic attack (TIA) is a transient stroke that lasts only a few minutes. It occurs when the blood supply to part of the brain is briefly interrupted. TIA symptoms, which usually occur suddenly, are similar to those of stroke but do not last as long. Most symptoms of a TIA disappear within an hour, although they may persist for up to 24 hours.

• Approximately one-third of the people who have a TIA will have another one.
• The age of onset varies, but incidence rises dramatically after age 50.
• TIA is more common among men and African-Americans.
• 2.7% of men age 65-69 will experience a TIA
• 1.6% of women age 65-69 will experience a TIA
• 3.6% of men age 75-79 will experience a TIA
• 4.1% of women age 75-79 will experience a TIA

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A TIA can be caused by:

• Narrowing of a blood vessel
• Blood clotting within an artery of the brain
• Blood clot traveling to the brain from somewhere else in the body (e.g., heart)
• A blood disease, cancer, and others
• Inflammation of blood vessels
• Injury to blood vessels

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Risk factors for TIA include:

• High blood pressure (hypertension)
• Heart disease
• Migraine headaches
• Smoking
• Diabetes
• Increasing age

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Symptoms of TIA are the same as those that occur in stroke and include the sudden development of:

• Numbness, tingling
• Weakness, heavy feeling of extremities
• Speech difficulty (garbled speech; slurred speech)
• Vision changes
  • Loss of vision in one eye
  • Decreased vision
  • Double vision
• Vertigo
• Loss of balance
• Lack of coordination
• Gait changes, staggering
• Falling

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“What Should I Ask” Screening Questions

1) When did the client have the last TIA?

Underwriting Comment: There is a postponement period between six to twelve months following the diagnosis of a TIA. The exact date of the last TIA is the starting point of the risk assessment process. TIAs are a precursor to strokes (brain attack). A significant number of clients who have a TIA will go on to have a stroke.

2) Has the client had more than one TIA?

Underwriting Comment: A single episode of a TIA is priced much differently than multiple episodes of TIAs. Multiple TIAs indicate a poor medical and underwriting outcome.

3) Does the client smoke or have histories of either diabetes or hypertension?

Underwriting Comment: The major risk factors for TIAs are a history of smoking, diabetes (insulin dependent or non-insulin dependent) or hypertension. It is important to know if these risk factors exist in the client's medical history. Poorly controlled diabetes or hypertension combined with smoking in clients who have had a TIA generally renders the client uninsurable for individual coverage.

4) Does the client have a history of either cardiac arrhythmias or heart valve disease?

Underwriting Comment: Irregular heart rhythms or disease of the heart valves can create clotting events that can present as TIAs. It is important to know if these risk factors exist in a client's medical history. Cardiac arrhythmias or heart valve disease combined with one or more TIAs generally renders the client uninsurable for individual coverage.

5) What are the current medications that the client is taking?

Underwriting Comment: Clients who experience one or more TIAs are placed on some form of clot prevention therapy (i.e. anti-coagulants). These medications include aspirin, Persantine, Plavix, Ticlid or Coumadin.

6) Has there been any reoccurrence of any of the symptoms that occurred with the last TIA?

Underwriting Comment: TIAs are by definition neurological changes that last for less than twenty-four hours (i.e. one-sided numbness, loss of the ability to speak, etc.). It is important to clarify if any of these symptoms have reoccurred since the last TIA. Reoccurring symptoms indicate clinical instability and generally render the client uninsurable for individual coverage.