Sex-related differences in the applicability and performance of the Montreal Cognitive Assessment in the acute phase of stroke

Introduction Early cognitive screening, although recommended, can be challenging in acute stroke settings. In patients with acute stroke, we aimed to evaluate (1) reasons and predictors of non-applicability of the Montreal Cognitive Assessment (MoCA) and (2) MoCA score performance, focusing on sex-related differences. Patients and methods We conducted a single-centre study on patients consecutively admitted to our stroke unit (June 2019–June 2023). Reasons for MoCA non-applicability and MoCA scores were compared between sexes. Univariate and multivariable analyses explored associations between MoCA applicability and sociodemographic/clinical characteristics. Results Out of 637 admitted patients (median age 78.8 years; 54.3% male; 81.2% ischemic stroke), 445 (69.8%) completed the MoCA (76.3% of males, 62.2% of females, P <.001). Reasons for non-applicability were acute stroke-related in 63.5% of cases (mainly altered consciousness and aphasia), prestroke conditions-related in 22.9% and other (refusal/unreported) in 13.5%. Stroke-related reasons were more frequent in females (P =.002) and refusal in males (P =.005). Variables associated with MoCA non-applicability were: NIHSS on admission in both females (adjusted odds ratio [adj.OR] 1.25, 95% CI, 1.16–1.34) and males (adj.OR 1.24, 95% CI, 1.14–1.34); pre-stroke mRS in females (adj.OR 1.58, 95% CI, 1.15–2.17) and years of education and left-hemisphere lesion in males (adj.OR 0.91, 95% CI, 0.84–1.00 and adj.OR 2.38, 95% CI, 1.16–4.86, respectively). Among tested patients, females showed lower raw and adjusted MoCA scores (P <.001 and P =.022, respectively). Conclusion Sex-specific factors influence feasibility and interpretation of early cognitive screening in the acute stroke phase: recognising these differences might guide future efforts towards more inclusive and individualised protocols.