Depressive and Anxiety Symptoms Predict Health-Related Quality of Life More Than Cognitive Impairment After Minor Stroke or Transient Ischemic Attack: A Hierarchical Regression Analysis

Background. Transient ischemic attack (TIA) and minor stroke often result in excellent functional recovery but are frequently followed by substantial psychological morbidity. It remains unclear whether mood disturbances or cognitive impairment are the primary contributors to reduced health-related quality of life (HRQoL) in this population. Methods. We conducted a prospective observational case–control study including 90 patients with acute TIA or minor stroke confirmed by diffusion-weighted imaging, and 92 age-matched healthy controls. At 90 days, participants completed the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Montreal Cognitive Assessment, and the EQ-5D-5L. Hierarchical multiple regression using standardized z-scores identified independent predictors of HRQoL. Bias-corrected bootstrapped mediation analyses (5,000 iterations) assessed whether cognitive impairment mediated the relationship between mood symptoms and HRQoL. Results: Compared with controls, patients exhibited markedly higher rates of depression (82.2% vs. 18.5%), anxiety (81.1% vs. 21.7%), and cognitive impairment (66.7% vs. 13.0%) (all p<0.001). Psychopathological variables explained an additional 36.6% of HRQoL variance, whereas cognitive and neuroimaging variables contributed only 1.7% (ΔR²=0.017; p=0.523). Anxiety showed the strongest predictive value (β=–0.055; p=0.064), while cognitive impairment had negligible effects (β=–0.001; p=0.947). Mediation analyses revealed no significant indirect effects, indicating that mood and cognitive complications arise independently rather than sequentially. Conclusions: Following TIA or minor stroke, depressive and anxiety symptoms are highly prevalent, persist despite good neurological recovery, and exert a disproportionately negative impact on HRQoL. Anxiety appears particularly influential in determining patient-reported outcomes, underscoring the need for routine mood screening and targeted psychological management in this population.