Post-stroke cognitive decline among women in midlife

Background: Stroke is a significant risk factor for cognitive impairment. Women face a heightened risk due to their longer life expectancy and the greater prevalence of stroke-related disability. Objective: To compare the trajectory of cognitive decline in women with and without a stroke diagnosis and assessed demographic differences. Design: The study employed a longitudinal, observational cohort design. Methods: The Study of Women’s Health Across the Nation interviewed women in their 40s and 50s from seven U.S. cities approximately yearly to collect information on their physical, biological, psychological, and social health. Cognitive assessments were conducted between 2000 (Wave 4) and 2008 (Wave 10) that were designed to examine information processing speed, working memory, immediate memory, and delayed memory. Adjusting for baseline age, race/ethnicity, income, education, marital status, comorbidities, and insurance, generalized linear mixed models were used to compare cognitive decline between women who had experienced a stroke and those who had not. Results: Among the 3302 women in the sample, age was 49.52 (SD = 2.64) years old at baseline and 53.74 (SD = 3.94) in the final wave. In Wave 4, only 0.67% ( N = 22) reported having been diagnosed with a stroke, but 8.39% ( N = 277) had been diagnosed by Wave 10. Compared to stroke-free women, the multivariable-adjusted changes in cognitive performance were −0.18 information processing, −0.09 working memory, −0.15 immediate memory, and −0.17 delayed memory. Compared to White women, Black women who suffered a stroke saw multivariable-adjusted annual changes in information processing, working memory, immediate memory, and delayed memory of −0.08, −0.03, −0.08, and −0.09, respectively. Conclusion: These findings underscore the persistent impact of stroke on multiple cognitive domains in midlife women, with a more significant decline observed among Black women. Targeted prevention and rehabilitation efforts are needed to address both the cognitive consequences of stroke and the demographic differences in post-stroke outcomes.