Sex-Specific Role of Cognitive Reserve in Activities of Daily Living Recovery After Subacute Stroke

Abstract

Objective

This study aimed to investigate the association between cognitive reserve (CR), measured using the Cognitive Reserve Index questionnaire (CRIq), and activities of daily living (ADL) outcomes among patients with stroke during the subacute phase, focusing on sex-related differences in CR and their impact on ADL recovery.

Results

Ninety-six stroke patients admitted to a rehabilitation ward were included, with demographic and clinical data collected from medical records. No significant sex differences in baseline characteristics were observed. Based on CRIq scores, 70.8% of patients were classified at a medium CR level, with no significant sex difference in composite CRIq scores. However, men scored higher in CRI-Working Activity (CRI-WA), whereas women scored higher in CRI-Leisure Time (CRI-LT). Least Absolute Shrinkage and Selection Operator (LASSO) regression revealed that better functional outcomes at discharge were associated with younger age, higher cognitive reserve, greater initial ADL function, and better motor ability. Additionally, a significant interaction between sex and cognitive reserve indicated a sex-specific effect on ADL recovery. In sex-stratified analyses, CRIq was a significant predictor of Modified Barthel Index (MBI) at discharge in men, along with age, MBI at admission, and Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Conversely, CRIq was not predictive in women, while FMA-LE and MBI at admission were significant predictors.

Conclusion

CR is an independent predictor of ADL outcomes, particularly in men, suggesting a sex-specific effect during the subacute phase of stroke. These findings underscore the importance of CR in recovery and support the need for more personalized rehabilitation strategies.