Poststroke Cognitive Outcomes: Sex Differences and Contributing Factors

Abstract

Background The study investigated sex differences in cognitive outcomes at 90 days after first‐ever stroke using data from a population‐based sample. Methods and Results The study sample consisted of 1227 participants from the 2009–2016 Brain Attack Surveillance in Corpus Christi project (south Texas, United States) who had first‐ever ischemic stroke or intracerebral hemorrhage and survived 90 days after stroke. Poststroke cognitive function was assessed by the Modified Mini‐Mental State Examination (3MSE) (range: 0–100; dementia: <78). The associations of sex with dichotomized and continuous outcomes were examined using logistic regression and tobit regression, respectively. Inverse probability weighting and multiple imputation were used to deal with missing data. The study sample was evenly distributed by sex, and primarily composed of Mexican Americans (59.1%) and non‐Hispanic whites (34.1%). Women scored 2.96 points worse on the 3MSE than men at 90 days poststroke (95% CI, −3.99 to −1.93). The prevalence of dementia was 27.6% for men (95% CI, 23.5%–31.6%) and 35.6% for women (95% CI, 31.5%–39.7%), and the unadjusted odds ratio (OR) of dementia comparing women with men was 1.45 (95% CI, 1.24–1.69). The association was attenuated after adjustment for sociodemographic, stroke, and prestroke characteristics (OR, 0.82; 95% CI, 0.61–1.09). Conclusions Women had worse cognitive outcomes than men at 90 days poststroke. The differences were attributable to sociodemographic and prestroke characteristics, especially widowhood status. Potential mechanisms linking widowhood to dementia in the acute poststroke stage warrant further investigation to inform interventions addressing the unique care needs of women stroke survivors with dementia and cognitive dysfunction.