Multivariate data analysis of sex differences in emotional and cognitive evaluations over 1 year after stroke

Abstract Post-stroke disabilities in cognition and mood lead to worse stroke recovery trajectory but are frequently overlooked. Although neurological factors and clinical history have been documented as important predictors of these invisible handicaps, the role of sex has not been given enough scrutiny. Examining sex-based differences in these outcomes could help deliver better post-stroke care. The goal of this study was to explore the interplay over one year between post-stroke cognitive and socio-affective assessments for men and women separately. Clinical evaluations of a monocentric hospital-based cohort including 263 patients with first-ever ischemic stroke were taken before hospital discharge and at 3- and 12-months post-stroke. Univariate comparisons between men and women were conducted, followed by multivariate analyses controlling for stroke severity, age, and education. Partial correlations between neuroradiological (stroke volume, white matter hyperintensities), cognitive (Montreal Cognitive Assessment test), mood (Hospital Anxiety and Depression scale; Apathy Inventory), and quality-of-life (Life Satisfaction Questionnaire-9) metrics were computed for both sexes. In multivariate analyses, women showed higher levels of baseline depression (padj < 0.05) and apathy Initiate (padj < 0.05) and Interest (padj < 0.001) subscores, as well as of anxiety at both follow-ups (padj < 0.05); they also endorsed lower scores in various quality-of-life sub-domains across all time points. Men had increasing levels of depression over time and showed stronger associations between psychological outcomes, including greater intercorrelations between cognitive assessments. Only spurious associations were found between clinical and neuroradiological characteristics for both sexes. Independently from stroke severity, age, and education, there were notable sex differences in the interplay between post-stroke cognitive and socio-affective functioning, suggesting differences in resilience and resistance to pathological burden. The inclusion of sex- and gender-specific factors in clinical evaluations seems critical to optimize post-stroke care strategies. Clinical Trial Registration: Trial name: Brain Before Stroke; ID: PHRC-12-152; URL: https://scanr.enseignementsup-recherche.gouv.fr/project/PHRC-12-152 .