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 and Purpose: Minor cerebrovascular events (TIA or minor ischemic stroke) are associated with substantial psychological morbidity, despite generally excellent functional recovery. This study investigated whether mood disturbances or cognitive impairment are the primary contributors to reduced quality of life in patients following minor cerebrovascular events. Methods: We conducted a prospective observational case–control study including 90 patients with acute TIA or minor ischemic stroke (NIHSS ≤ 4) confirmed by diffusion-weighted imaging, and 92 age-matched healthy controls. At 90 days post-event, participants underwent assessment with the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Montreal Cognitive Assessment, and the EQ-5D-5L quality-of-life utility index. Hierarchical multiple regression using standardized z-scores identified independent predictors of quality of life. Mediation analysis with 5,000-iteration bias-corrected bootstrap confidence intervals tested whether cognitive impairment mediated the relationship between mood symptoms and quality of life. Results: Compared with controls, cases showed markedly higher rates of clinical depression (82.2% vs. 18.5%), anxiety (81.1% vs. 21.7%), and cognitive impairment (66.7% vs. 13.0%; all p < 0.001). Hierarchical regression revealed that psychopathological variables (depression/anxiety) explained an additional 36.6% of the variance in quality of life (p < 0.001), whereas cognitive and neuroimaging variables contributed an additional 1.7% (ΔR²=0.017; incremental p = 0.523 ). Anxiety emerged as the strongest predictor at trend-level (β=−0.055; p = 0.064†), whereas cognitive impairment showed a negligible effect (β = − 0.001, p = 0.947). Mediation analysis demonstrated no significant indirect effects, suggesting that mood disturbances and cognitive impairment are independent, rather than sequential, post-event complications. Conclusions: Following TIA or minor ischemic stroke, depressive and anxiety symptoms are common, persist despite excellent neurological recovery, and exert a substantial negative impact on health-related quality of life. Anxiety appears to play a particularly prominent role in shaping patient-reported outcomes, underscoring the importance of routine mood screening and targeted management in this population.