Exalto, L. G. et al. (2023) Sex differences in post-stroke cognitive impairment: a multicenter study in 2343 patients with acute ischemic stroke. Stroke, 54(9), pp. 2296-2303. (doi: 10.1161/STROKEAHA.123.042507) (PMID:37551589) (PMCID:PMC10453354)
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Abstract
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.
| Item Type: | Articles |
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| Additional Information: | Dr Exalto is supported by Alzheimer Nederland WE.03-2019-15 and Nether-lands CardioVascular Research Initiative: the Dutch Heart Foundation (CVON 2018-28 & 2012-06). The Meta-VCI Map consortium is supported by Vici Grant 918.16.616 from The Netherlands Organisation for Health Research and Development (ZonMw) to Dr Biessels. Harmonization analyses were supported by a Rudolf Magnus Young Talent Fellowship from the University Medical Center Utrecht Brain Center to Dr Biesbroek. The CASPER cohort was supported by Maastricht University, Health Foundation Limburg, and Stichting Adriana van Rinsum-Ponsen. The CROMIS-2 cohort was funded by the UK Stroke Associa-tion and the British Heart Foundation (grant number TSA BHF 2009/01). The CU-STRIDE cohort was supported by the Health and Health Services Research Fund of the Food and Health Bureau of the Government of Hong Kong (grant number 0708041), the Lui Che Woo Institute of Innovative Medicine, and Therese Pei Fong Chow Research Center for Prevention of Dementia. The GRECogVASC cohort was funded by Amiens University Hospital and by a grant from the French Ministry of Health (grant number DGOS R1/2013/144). The MSS-2 cohort is funded by the Wellcome Trust (grant number WT088134/Z/09/A to Dr Ward-law) and the Row Fogo Charitable Trust. The PROCRAS cohort was funded via ZonMW as part of the TopZorg project in 2015 (grant number 842003011). The CODECS cohort (ongoing) is supported by a grant from Stichting Coolsingel (grant number 514). The Bundang VCI and Hallym VCI cohort groups do not wish to report any relevant funding sources. At the time of contribution, Dr Hamilton was funded by the College of Medicine and Veterinary Medicine at the University of Edinburgh and was supported by the Wellcome Trust through the Translational Neuroscience PhD program at the University of Edinburgh. Dr Aben reports grants from ZonMW (grant number 842003011). Dr Chen re-ports grants from the National Medical Research Council (NMRC) of Singapore and National University of Singapore. Dr Godefroy reports grants from Amiens University Hospital and the French Ministry of Health, during the last 5 years Dr Godefroy has served on scientific advisory boards and as a speaker for No-vartis, CSL-Behring, Biogen, Genzyme, Lilly, Bristol-Myers Squibb, Boehringer-Ingelheim, Covidien, Teva Santé, and Astra Zeneca. Dr Hamilton is supported by the Medical Research Council (MC_UU_00022/2) and the Scottish Chief Scien-tist Office (SPHSU17). Dr Köhler reports grants from Nederlandse Organisatie voor Wetenschappelijk Onderzoek and grants from ZonMw. Dr Wardlaw reports grants from the Wellcome Trust, Row Fogo Charitable Trust, and the UK Medical Research Council. Dr Werring has received: grant funding from the Stroke As-sociation and British Heart Foundation; speaking honoraria from Bayer; speaking and chairing honoraria from Alexion and NovoNordisk; and consultancy fees from Bayer and NovoNordisk. Dr Biessels reports grants from ZonMW and Hartsticht-ing. The other authors report no conflicts. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Hamilton, Dr Olivia |
| Authors: | Exalto, L. G., Weaver, N. A., Kuijf, H. J., Aben, H. P., Bae, H.-J., Best, J. G., Bordet, R., Chen, C. P.L.H., van der Giessen, R. S., Godefroy, O., Gyanwali, B., Hamilton, O. K.L., Hilal, S., Huenges Wajer, I. M.C., Kim, J., Kappelle, L. J., Kim, B. J., Köhler, S., de Kort, P. L.M., Koudstaal, P. J., Lim, J.-S., Makin, S. D.J., Mok, V. C.T., van Oostenbrugge, R. J., Roussel, M., Staals, J., del C. Valdés-Hernández, M., Venketasubramanian, N., Verhey, F. R.J., Wardlaw, J. M., Werring, D. J., Xu, X., van Zandvoort, M. J.E., Biesbroek, J. M., Chappell, F. M., and Biessels, G. J. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU |
| Journal Name: | Stroke |
| Publisher: | American Heart Association |
| ISSN: | 0039-2499 |
| ISSN (Online): | 1524-4628 |
| Published Online: | 08 August 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in Stroke 54(9):2296-2303 |
| Publisher Policy: | Reproduced under a Creative Commons license |
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