Sex Differences in Poststroke Cognitive Impairment: A Multicenter Study in 2343 Patients With Acute Ischemic Stroke.
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Exalto Lieza G, Weaver Nick A, Kuijf Hugo J, Aben Hugo P, Bae Hee-Joon, Best Jonathan G, Bordet Régis, Chen Christopher P L H, van der Giessen Ruben S, Godefroy Olivier, Gyanwali Bibek, Hamilton Olivia K L, Hilal Saima, Huenges Wajer Irene M C, Kim Jonguk, Kappelle L Jaap, Kim Beom Joon, Köhler Sebastian, de Kort Paul L M, Koudstaal Peter J, Lim Jae-Sung, Makin Stephen D J, Mok Vincent C T, van Oostenbrugge Robert J, Roussel Martine, Staals Julie, Valdés-Hernández Maria Del C, Venketasubramanian Narayanaswamy, Verhey Frans R J, Wardlaw Joanna M, Werring David J, Xu Xin, van Zandvoort Martine J E, Biesbroek J Matthijs, Chappell Francesca M, Biessels Geert Jan
Аннотация
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.