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. Koudstaal; Jae 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

doi:10.1161/STROKEAHA.123.042507

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

Applied Health Sciences

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

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.

Original language	English
Pages (from-to)	2296-2303
Number of pages	8
Journal	Stroke
Volume	54
Issue number	9
Early online date	8 Aug 2023
DOIs	https://doi.org/10.1161/STROKEAHA.123.042507
Publication status	Published - 1 Sept 2023

Bibliographical note

Funding Information:
Dr Exalto is supported by Alzheimer Nederland WE.03-2019-15 and Netherlands 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 Association 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 Wardlaw) 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.

Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.

Keywords

cognition
ischemic stroke
men
survivors
women

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10.1161/STROKEAHA.123.042507

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© 2023 The Authors. Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.https://doi.org/10.1161/STROKEAHA.123.042507open_in_new
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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., ... Biessels, G. J. (2023). Sex Differences in Poststroke Cognitive Impairment: A Multicenter Study in 2343 Patients With Acute Ischemic Stroke. Stroke, 54(9), 2296-2303. https://doi.org/10.1161/STROKEAHA.123.042507

Exalto, LG, Weaver, NA, Kuijf, HJ, Aben, HP, Bae, HJ, Best, JG, Bordet, R, Chen, CPLH, Van Der Giessen, RS, Godefroy, O, Gyanwali, B, Hamilton, OKL, Hilal, S, Huenges Wajer, IMC, Kim, J, Kappelle, LJ, Kim, BJ, Köhler, S, De Kort, PLM, Koudstaal, PJ, Lim, JS, Makin, SDJ, Mok, VCT, Van Oostenbrugge, RJ, Roussel, M, Staals, J, Valdés-Hernández, MDC, Venketasubramanian, N, Verhey, FRJ, Wardlaw, JM, Werring, DJ, Xu, X, Van Zandvoort, MJE, Biesbroek, JM, Chappell, FM & Biessels, GJ 2023, 'Sex Differences in Poststroke Cognitive Impairment: A Multicenter Study in 2343 Patients With Acute Ischemic Stroke', Stroke, vol. 54, no. 9, pp. 2296-2303. https://doi.org/10.1161/STROKEAHA.123.042507

@article{a516e4daf56f4c31a9e2ba083d69f576,

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

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.",

keywords = "cognition, ischemic stroke, men, survivors, women",

author = "Exalto, {Lieza G.} and Weaver, {Nick A.} and Kuijf, {Hugo J.} and Aben, {Hugo P.} and Bae, {Hee Joon} and Best, {Jonathan G.} and R{\'e}gis Bordet and Chen, {Christopher P.L.H.} and {Van Der Giessen}, {Ruben S.} and Olivier Godefroy and Bibek Gyanwali and Hamilton, {Olivia K.L.} and Saima Hilal and {Huenges Wajer}, {Irene M.C.} and Jonguk Kim and Kappelle, {L. Jaap} and Kim, {Beom Joon} and Sebastian K{\"o}hler and {De Kort}, {Paul L.M.} and Koudstaal, {Peter J.} and Lim, {Jae Sung} and Makin, {Stephen D.J.} and Mok, {Vincent C.T.} and {Van Oostenbrugge}, {Robert J.} and Martine Roussel and Julie Staals and Vald{\'e}s-Hern{\'a}ndez, {Maria Del C.} and Narayanaswamy Venketasubramanian and Verhey, {Frans R.J.} and Wardlaw, {Joanna M.} and Werring, {David J.} and Xin Xu and {Van Zandvoort}, {Martine J.E.} and Biesbroek, {J. Matthijs} and Chappell, {Francesca M.} and Biessels, {Geert Jan}",

note = "Funding Information: Dr Exalto is supported by Alzheimer Nederland WE.03-2019-15 and Netherlands 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 Association 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 Wardlaw) 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. Publisher Copyright: {\textcopyright} 2023 Lippincott Williams and Wilkins. All rights reserved.",

year = "2023",

month = sep,

day = "1",

doi = "10.1161/STROKEAHA.123.042507",

language = "English",

volume = "54",

pages = "2296--2303",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins",

number = "9",

}

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 - Funding Information: Dr Exalto is supported by Alzheimer Nederland WE.03-2019-15 and Netherlands 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 Association 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 Wardlaw) 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. 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 -

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

Abstract

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

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

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