Gender differences in post-stroke cognitive outcomes in rehabilitation: insights from MoCA domain index scores

Recent literature revealed gender differences in both motor and cognitive deficits after stroke. Women appear to be at a greater disadvantage in terms of recovery, probably for biological and social factors. This post-hoc observational study examined gender differences in global cognitive functioning and across specific cognitive domains in subacute ischemic stroke patients undergoing integrated conventional and robotic multidomain rehabilitation. Cognitive performance was measured before and after a six-week rehabilitation treatment through the Montreal Cognitive Assessment (MoCA). To better characterize domain specific cognitive profiles, the Cognitive Domain Index Scores (CDIS) for executive functions, visuospatial skills, language, attention and orientation were derived from the test. The Brunner-Langer test was performed to account for the main effect of time and the interaction effect between time and gender. The Mann-Whitney U test was used to compare CDIS scores between men and women at T0 and T1. We analyzed 66 patients affected by an ischemic insult (69.5 years ± 10.9; 33 women). The sample was gender-balanced and homogeneous for demographic and clinical characteristics. At baseline, women demonstrated lower MoCA compared to men (p = 0.018). Following rehabilitation, both groups showed comparable improvements (p < 0.001); however, the initial gender difference remained unchanged at discharge. Analysis of the CDIS indicated distinct cognitive profiles between men and women. The CDIS derived from the MoCA allows an easy and rapid identification of domain-specific cognitive deficits, thus providing more detailed information than the global MoCA score. This enables individualized cognitive rehabilitation planning, that also takes gender disparities into account.