Sex Differences in Poststroke Cognitive Impairment: A Multicenter Study in 2343 Patients With Acute Ischemic Stroke-Reference-Cited by-同舟云学术

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

Published:2023-09 Issue:9 Volume:54 Page:2296-2303
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Exalto Lieza G.¹^ORCID,Weaver Nick A.¹^ORCID,Kuijf Hugo J.²^ORCID,Aben Hugo P.³^ORCID,Bae Hee-Joon⁴^ORCID,Best Jonathan G.⁵,Bordet Régis⁶^ORCID,Chen Christopher P.L.H.⁷⁸^ORCID,van der Giessen Ruben S.⁹^ORCID,Godefroy Olivier¹⁰^ORCID,Gyanwali Bibek⁸,Hamilton Olivia K.L.¹¹¹²¹³^ORCID,Hilal Saima⁷⁸¹⁴^ORCID,Huenges Wajer Irene M.C.¹¹⁵,Kim Jonguk⁴^ORCID,Kappelle L. Jaap¹^ORCID,Kim Beom Joon⁴^ORCID,Köhler Sebastian¹⁶^ORCID,de Kort Paul L.M.³^ORCID,Koudstaal Peter J.⁹^ORCID,Lim Jae-Sung¹⁷^ORCID,Makin Stephen D.J.¹⁸^ORCID,Mok Vincent C.T.¹⁹²⁰,van Oostenbrugge Robert J.²¹^ORCID,Roussel Martine¹⁰,Staals Julie²¹^ORCID,Valdés-Hernández Maria del C.¹¹¹²^ORCID,Venketasubramanian Narayanaswamy²²^ORCID,Verhey Frans R.J.¹⁶,Wardlaw Joanna M.¹¹¹²^ORCID,Werring David J.⁵^ORCID,Xu Xin⁷⁸^ORCID,van Zandvoort Martine J.E.¹¹⁵^ORCID,Biesbroek J. Matthijs¹²³^ORCID,Chappell Francesca M.²⁴^ORCID,Biessels Geert Jan¹^ORCID

Affiliation:

1. Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, the Netherlands (L.G.E., N.A.W., I.M.C.H.W., L.J.K., M.J.E.v.Z., J.M.B., G.J.B.).

2. Image Sciences Institute, University Medical Center Utrecht, the Netherlands (H.J.K.).

3. Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands (H.P.A., P.L.M.d.K.).

4. Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea (H.-J.B., J.K., B.J.K.).

5. Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (J.G.B., D.J.W.).

6. Université Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-Lille, France (R.B.).

7. Department of Pharmacology, National University of Singapore (C.P.L.H.C., S.H., X.X.).

8. Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore (C.P.L.H.C., B.G., S.H., X.X.).

9. Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (R.S.v.d.G., P.J.K.).

10. Department of Neurology, Amiens University hospital, Laboratory of Functional Neurosciences, Jules Verne Picardy University, France (O.G., M.R.).

11. Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (O.K.L.H., M.d.C.V.-H., J.M.W.).

12. UK Dementia Research Institute at the University of Edinburgh, United Kingdom (O.K.L.H., M.d.C.V.-H., J.M.W.).

13. MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing (O.K.L.H.), University of Glasgow, United Kingdom.

14. Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (S.H.).

15. Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands (I.M.C.H.W., M.J.E.v.Z.).

16. Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, the Netherlands (S.K., F.R.J.V.).

17. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.-S.L.).

18. Centre For Rural Health, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom (S.D.J.M.).

19. Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M.), The Chinese University of Hong Kong.

20. Therese Pei Fong Chow Research Centre for Prevention of Dementia, Margaret Kam Ling Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre (V.C.T.M.), The Chinese University of Hong Kong.

21. Department of Neurology, Maastricht University Medical Center, the Netherlands (R.J.v.O., J.S.).

22. Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore (N.V.).

23. Department of Neurology, Diakonessenhuis Hospital, Utrecht, the Netherlands (J.M.B.).

24. Social and Public Health Sciences Unit (F.M.C.), University of Glasgow, United Kingdom.

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

Reference31 articles.

1. Top ten research priorities relating to life after stroke

2. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study

3. Systematic Review and Meta-Analysis of Prevalence in Post-Stroke Neurocognitive Disorders in Hospital-Based Studies

4. Poststroke Cognitive Impairment Negatively Impacts Activity and Participation Outcomes

5. Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke

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