TY - JOUR
T1 - Sex Differences in Poststroke Cognitive Impairment
T2 - A Multicenter Study in 2343 Patients With Acute Ischemic Stroke
AU - Exalto, Lieza G.
AU - Weaver, Nick A.
AU - Kuijf, Hugo J.
AU - Aben, Hugo P.
AU - Bae, Hee Joon
AU - Best, Jonathan G.
AU - Bordet, Régis
AU - Chen, Christopher P.L.H.
AU - Van Der Giessen, Ruben S.
AU - Godefroy, Olivier
AU - Gyanwali, Bibek
AU - Hamilton, Olivia K.L.
AU - Hilal, Saima
AU - Huenges Wajer, Irene M.C.
AU - Kim, Jonguk
AU - Kappelle, L. Jaap
AU - Kim, Beom Joon
AU - Köhler, Sebastian
AU - De Kort, Paul L.M.
AU - Koudstaal, Peter J.
AU - Lim, Jae Sung
AU - Makin, Stephen D.J.
AU - Mok, Vincent C.T.
AU - Van Oostenbrugge, Robert J.
AU - Roussel, Martine
AU - Staals, Julie
AU - Valdés-Hernández, Maria Del C.
AU - Venketasubramanian, Narayanaswamy
AU - Verhey, Frans R.J.
AU - Wardlaw, Joanna M.
AU - Werring, David J.
AU - Xu, Xin
AU - Van Zandvoort, Martine J.E.
AU - Biesbroek, J. Matthijs
AU - Chappell, Francesca M.
AU - Biessels, Geert Jan
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - BACKGROUND: Poststroke cognitive impairment (PSCI) occurs in about half of stroke survivors. Cumulative evidence indicates that functional outcomes of stroke are worse in women than men. Yet it is unknown whether the occurrence and characteristics of PSCI differ between men and women. METHODS: Individual patient data from 9 cohorts of patients with ischemic stroke were harmonized and pooled through the Meta-VCI-Map consortium (n=2343, 38% women). We included patients with visible symptomatic infarcts on computed tomography/magnetic resonance imaging and cognitive assessment within 15 months after stroke. PSCI was defined as impairment in ≥1 cognitive domains on neuropsychological assessment. Logistic regression analyses were performed to compare men to women, adjusted for study cohort, to obtain odds ratios for PSCI and individual cognitive domains. We also explored sensitivity and specificity of cognitive screening tools for detecting PSCI, according to sex (Mini-Mental State Examination, 4 cohorts, n=1814; Montreal Cognitive Assessment, 3 cohorts, n=278). RESULTS: PSCI was found in 51% of both women and men. Men had a lower risk of impairment of attention and executive functioning (men: odds ratio, 0.76 [95% CI, 0.61-0.96]), and language (men: odds ratio, 0.67 [95% CI, 0.45-0.85]), but a higher risk of verbal memory impairment (men: odds ratio, 1.43 [95% CI, 1.17-1.75]). The sensitivity of Mini-Mental State Examination (<25) for PSCI was higher for women (0.53) than for men (0.27; P=0.02), with a lower specificity for women (0.80) than men (0.96; P=0.01). Sensitivity and specificity of Montreal Cognitive Assessment (<26.) for PSCI was comparable between women and men (0.91 versus 0.86; P=0.62 and 0.29 versus 0.28; P=0.86, respectively). CONCLUSIONS: Sex was not associated with PSCI occurrence but affected domains differed between men and women. The latter may explain why sensitivity of the Mini-Mental State Examination for detecting PSCI was higher in women with a lower specificity compared with men. These sex differences need to be considered when screening for and diagnosing PSCI in clinical practice.
AB - BACKGROUND: Poststroke cognitive impairment (PSCI) occurs in about half of stroke survivors. Cumulative evidence indicates that functional outcomes of stroke are worse in women than men. Yet it is unknown whether the occurrence and characteristics of PSCI differ between men and women. METHODS: Individual patient data from 9 cohorts of patients with ischemic stroke were harmonized and pooled through the Meta-VCI-Map consortium (n=2343, 38% women). We included patients with visible symptomatic infarcts on computed tomography/magnetic resonance imaging and cognitive assessment within 15 months after stroke. PSCI was defined as impairment in ≥1 cognitive domains on neuropsychological assessment. Logistic regression analyses were performed to compare men to women, adjusted for study cohort, to obtain odds ratios for PSCI and individual cognitive domains. We also explored sensitivity and specificity of cognitive screening tools for detecting PSCI, according to sex (Mini-Mental State Examination, 4 cohorts, n=1814; Montreal Cognitive Assessment, 3 cohorts, n=278). RESULTS: PSCI was found in 51% of both women and men. Men had a lower risk of impairment of attention and executive functioning (men: odds ratio, 0.76 [95% CI, 0.61-0.96]), and language (men: odds ratio, 0.67 [95% CI, 0.45-0.85]), but a higher risk of verbal memory impairment (men: odds ratio, 1.43 [95% CI, 1.17-1.75]). The sensitivity of Mini-Mental State Examination (<25) for PSCI was higher for women (0.53) than for men (0.27; P=0.02), with a lower specificity for women (0.80) than men (0.96; P=0.01). Sensitivity and specificity of Montreal Cognitive Assessment (<26.) for PSCI was comparable between women and men (0.91 versus 0.86; P=0.62 and 0.29 versus 0.28; P=0.86, respectively). CONCLUSIONS: Sex was not associated with PSCI occurrence but affected domains differed between men and women. The latter may explain why sensitivity of the Mini-Mental State Examination for detecting PSCI was higher in women with a lower specificity compared with men. These sex differences need to be considered when screening for and diagnosing PSCI in clinical practice.
KW - cognition
KW - ischemic stroke
KW - men
KW - survivors
KW - women
UR - http://www.scopus.com/inward/record.url?scp=85169180706&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.123.042507
DO - 10.1161/STROKEAHA.123.042507
M3 - Article
C2 - 37551589
AN - SCOPUS:85169180706
SN - 0039-2499
VL - 54
SP - 2296
EP - 2303
JO - Stroke
JF - Stroke
IS - 9
ER -