Women with subacute ischemic stroke demonstrated lower baseline global cognitive scores than men, and while both sexes showed comparable improvements following six weeks of integrated rehabilitation, the initial gender difference remained unchanged at discharge, with distinct domain-specific cognitive profiles identified between groups.
Key Findings
Results
Women with subacute ischemic stroke had significantly lower global cognitive functioning at baseline compared to men.
Baseline cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) before a six-week rehabilitation program.
Women demonstrated lower MoCA scores compared to men at baseline (p = 0.018).
The sample consisted of 66 patients (mean age 69.5 years ± 10.9) with 33 women, described as 'gender-balanced and homogeneous for demographic and clinical characteristics.'
The study population had ischemic stroke and was in the subacute phase undergoing integrated conventional and robotic multidomain rehabilitation.
Results
Both men and women showed statistically significant cognitive improvements following six weeks of rehabilitation, but the magnitude of improvement was comparable between genders.
Cognitive improvements were observed in both groups following rehabilitation (p < 0.001).
The Brunner-Langer test was used to assess the main effect of time and the interaction effect between time and gender.
Despite both groups improving, the interaction between time and gender was not significant, indicating comparable improvements across sexes.
Rehabilitation consisted of a six-week integrated conventional and robotic multidomain program.
Results
The initial gender difference in global cognitive scores remained unchanged at discharge following rehabilitation.
Despite both groups showing improvements, women's cognitive disadvantage relative to men persisted at the end of the rehabilitation period (T1).
The Mann-Whitney U test was used to compare scores between men and women at both T0 (baseline) and T1 (discharge).
The persistence of the gender gap suggests that standard rehabilitation did not differentially benefit women enough to close the baseline disparity.
Authors note that women appear to be 'at a greater disadvantage in terms of recovery, probably for biological and social factors.'
Results
Men and women exhibited distinct domain-specific cognitive profiles as measured by Cognitive Domain Index Scores (CDIS) derived from the MoCA.
CDIS were derived from the MoCA for five domains: executive functions, visuospatial skills, language, attention, and orientation.
Analysis of the CDIS indicated 'distinct cognitive profiles between men and women.'
The Mann-Whitney U test was used to compare CDIS scores between men and women at T0 and T1.
Domain-specific differences were not fully captured by the global MoCA score alone, highlighting the added value of the CDIS approach.
Discussion
The Cognitive Domain Index Scores derived from the MoCA provide more detailed cognitive profiling than the global MoCA score and enable individualized rehabilitation planning.
The authors state that '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.'
Five cognitive domains were assessed: executive functions, visuospatial skills, language, attention, and orientation.
The CDIS approach is presented as enabling 'individualized cognitive rehabilitation planning, that also takes gender disparities into account.'
This was described as a post-hoc observational study, and the CDIS methodology was applied to an existing dataset of 66 ischemic stroke patients.
What This Means
This research suggests that women who suffer an ischemic stroke start cognitive rehabilitation with meaningfully lower thinking and memory abilities compared to men, even when the two groups are similar in age, clinical characteristics, and stroke severity. After six weeks of a combined conventional and robotic rehabilitation program, both men and women improved their cognitive scores by a comparable amount — but because women started lower, they also finished lower, meaning the gap between men and women did not close by the end of treatment. This finding points to a persistent cognitive disadvantage for women that standard rehabilitation, as currently delivered, may not fully address.
The study also found that looking at specific thinking skills separately — such as executive functions, visuospatial abilities, language, attention, and orientation — revealed different patterns of strengths and weaknesses between men and women that a single overall test score would miss. The researchers used a method called Cognitive Domain Index Scores (CDIS), which breaks the commonly used Montreal Cognitive Assessment (MoCA) test into these five areas, providing a richer picture of each patient's cognitive profile without requiring additional testing.
This research suggests that stroke rehabilitation programs may benefit from routinely assessing cognitive performance in a domain-specific way and accounting for gender differences when planning individualized treatment. The fact that women consistently showed a cognitive disadvantage that persisted through rehabilitation raises questions about whether current rehabilitation approaches are optimally designed for women, and whether gender-tailored strategies could help close this gap. The study was relatively small (66 patients) and observational in design, so larger prospective studies would be needed to confirm these findings and test targeted interventions.
Habib V, Siotto M, Germanotta M, Cocco C, Cipollini V, Papadopoulou D, et al.. (2026). Gender differences in post-stroke cognitive outcomes in rehabilitation: insights from MoCA domain index scores.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1837173