Occurrence of Post-Stroke Cognitive Impairment Equal in Women and Men

The occurrence of poststroke cognitive impairment (PSCI) did not differ between women and men; however, the cognitive profile of PSCI did differ.

Sex does not have an association with poststroke cognitive impairment (PSCI) occurrence; however, a higher sensitivity of the Mini-Mental State Examination (MMSE) was observed in women, while men exhibited lower specificity, according to study findings published in the journal Stroke.

Researchers conducted a multicenter study and reported on the occurrence and types of PSCI in patients with acute ischemic stroke, along with exploring sex differences in the sensitivity and specificity of cognitive screening tools for identifying PSCI.

Data from 9 cohorts of ischemic stroke patients (n=2343) were combined through the Meta-VCI-Map consortium. The researchers included patients with visible symptomatic infarcts on computed tomography scan/magnetic resonance imaging and cognitive assessment within 15 months poststroke.

PSCI was characterized by cognitive impairment in 1 or more domains, as assessed by neuropsychologic evaluation. These impairments align with the VASCOG criteria for Vascular Cognitive Disorders.

PSCI was equally common in women and men, but that the cognitive profiles differed between sexes.

Of those included, women were older (mean [SD] age, 68.3 [12.3] years) compared with men (mean [SD] age, 64.9 [11.3] years). Additionally, stroke severity was higher in women than in men, defined by the National Institutes of Health Stroke Scale (NIHSS).

PSCI was present in 51% of both women and men, with age-adjusted differences of -1% [95% CI, -5 to 4]. There was no significant gender disparity in the prevalence of PSCI ([odds ratio] OR, 1.03; 95% CI, 0.87-1.21).

In comparison with women, men exhibited a lower likelihood of experiencing attention and executive functioning impairment (men; OR, 0.76; 95% CI, 0.61–0.96) as well as language impairment (men; OR, 0.67; 95% CI, 0.45–0.85). Conversely, men demonstrated an increased risk for verbal memory impairment (men; OR, 1.43; 95% CI, 1.17–1.75).

Of the 9 cohorts that underwent a multidomain neuropsychologic assessment, 4 cohorts (n=1814, missing score n=1) utilized the MMSE as a cognitive screening tool, while 3 other cohorts (n=278, missing score n=22) relied on the Montreal cognitive assessment (MoCA). In the remaining 2 cohorts (n=251), no cognitive screening test was available.

The MMSE results indicated higher sensitivity in detecting PSCI in women (0.53) compared with men (0.27; P =.02), although with lower specificity in women (0.80) compared with men (0.96; P =.01). Conversely, the MoCA demonstrated similar sensitivity and specificity in detecting PSCI in both women and men (0.91 vs 0.86; P =.62; .29 vs .28; P =.86, respectively).

The researchers concluded, “PSCI was equally common in women and men, but that the cognitive profiles differed between sexes. Women more often had impairment in the domains of attention, executive functioning, and language, whereas men more often had impairment in verbal memory. In addition, the MMSE had a higher sensitivity in women compared with men, but the specificity was lower in women compared with men.”

A potential limitation of this study included the underrepresentation of women in stroke research. Furthermore, a higher percentage of men compared to women were included within the analysis.

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Exalto LG, Weaver NA, Kuijf HJ, et al. Sex differences in poststroke cognitive impairment: a multicenter study in 2343 patients with acute ischemic stroke. Stroke. Published online August 8, 2023. doi:10.1161/STROKEAHA.123.042507