Sex Differences in Poststroke Cognitive Impairment: A Multicenter Study in 2343 Patients With Acute Ischemic Stroke

Lieza G Exalto*, Nick A Weaver, Hugo J Kuijf, Hugo P Aben, Hee-Joon Bae, Jonathan G Best, Régis Bordet, Christopher P L H Chen, Ruben S van der Giessen, Olivier Godefroy, Bibek Gyanwali, Olivia K L Hamilton, Saima Hilal, Irene M C Huenges Wajer, Jonguk Kim, L Jaap Kappelle, Beom Joon Kim, Sebastian Köhler, Paul L M de Kort, Peter J KoudstaalJae-Sung Lim, Stephen D J Makin, Vincent C T Mok, Robert J van Oostenbrugge, Martine Roussel, Julie Staals, Maria Del C Valdés-Hernández, Narayanaswamy Venketasubramanian, Frans R J Verhey, Joanna M Wardlaw, David J Werring, Xin Xu, Martine J E van Zandvoort, J Matthijs Biesbroek, Francesca M Chappell, Geert Jan Biessels

*Corresponding author for this work

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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.

Original languageEnglish
Pages (from-to)2296-2303
Number of pages8
Issue number9
Early online date8 Aug 2023
Publication statusPublished - 1 Sept 2023


  • cognition
  • ischemic stroke
  • men
  • survivors
  • women


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