Gayaneh Nazarian B.S1, Vardan T. Karamyan Ph.D2
Oakland University William Beaumont School of Medicine
Gender Differences in Stroke Recovery
- Stroke is the world’s 2nd leading cause of long-term disability, with >13 million new cases and 5.5 million deaths annually¹,².
- Despite advances in acute care, ~50% of survivors face lasting functional challenges³.
- Recovery differs between men and women, influenced by biological and social factors⁴,⁵.
- This study explores gender disparities in functional outcomes, rehabilitation responses, and emerging neurorestorative therapies⁶-⁸.
- Examine gender differences in stroke recovery.
- Evaluate functional outcomes, rehabilitation responses, and neurorestorative therapies.
- Highlight biological and social factors influencing recovery disparities.
- Narrative systematic review: population-based studies, prospective cohorts, systematic reviews, RCTs¹,⁴,⁷-⁹.
- Focus areas: post-stroke function, physical activity, rehabilitation effectiveness, quality of life¹⁰,¹¹.
- Neurorestorative interventions: vagus nerve stimulation (VNS), non-invasive brain stimulation, task-specific motor therapy, pharmacologic adjuncts¹⁰,¹¹.
- Population: ischemic and hemorrhagic strokes to reflect real-world recovery⁷.
Functional Recovery
- Women have poorer outcomes despite similar survival.
- Poor functional outcomes at discharge (40% vs 31%), 3 months (32% vs 21%), 1 year (31% vs 19%)⁷ [Figure 1].
- Women experience higher pain scores and persistent deficits after rehab¹².
Physical Activity
- Men increase and maintain activity; women’s activity declines, linking to worse recovery¹³ [Figure 2].
Long-Term Outcomes
- Women report lower quality of life, higher care needs, and greater likelihood of long-term institutionalization¹³,¹⁴.
Neurorestorative Therapies
- VNS + rehab improves motor function⁷.
- Other therapies (VR, task-specific rehab) show mixed results; few studies examine sex-specific responses¹².
Biological & Social Factors
- Hormonal changes and lower caregiver support worsen outcomes.
- Only 37% of women vs 93% of men have a primary caregiver⁵ [Figure 3].
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- Katan M, Luft A. Global burden of stroke. Semin Neurol. 2018;38(2):208–211. doi:10.1055/s-0038-1649503
- GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.
- Kim JS, Lee KB, Roh H, Ahn MY, Hwang HW. Gender differences in the functional recovery after acute stroke. J Clin Neurol. 2010;6(4):183–188. doi:10.3988/jcn.2010.6.4.183
- Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Stroke. 2009;40(6):2348–2355. doi:10.1161/STROKEAHA.109.192064
- Roth DL, Haley WE, Clay OJ, et al. Race and gender differences in 1-year outcomes for community-dwelling stroke survivors with family caregivers. Stroke. 2011;42(3):626–631. doi:10.1161/STROKEAHA.110.595322
- Buvarp D, Viktorisson A, Axelsson F, et al. Physical activity trajectories and functional recovery after acute stroke among adults in Sweden. JAMA Netw Open.
- Kim JS, Lee KB, Roh H, Ahn MY, Hwang HW. Gender differences in the functional recovery after acute stroke. J Clin Neurol. 2010;6(4):183–188.
- Circulation Research. Sex differences in post-stroke outcomes and recovery. 2021. doi:10.1161/CIRCRESAHA.121.319915
- Buvarp D, Viktorisson A, Axelsson F, et al. Physical activity trajectories and functional recovery after acute stroke among adults in Sweden. JAMA Netw Open. 2023;6(5):e2310919. doi:10.1001/jamanetworkopen.2023.10919
- Dawson J, Liu CY, Francisco GE, et al. Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischemic stroke (VNS-REHAB): a randomized, blinded trial. Lancet. 2021;397:1545–1553. doi:10.1016/S0140-6736(21)00575-2
- Saposnik G, Cohen LG, Mamdani M, et al. Efficacy of non-immersive virtual reality rehabilitation in patients with chronic stroke. Stroke. 2016;47:1020–1026. doi:10.1161/STROKEAHA.115.011616
- Kautzky-Willer A, Harreiter J, Thomas A, et al. Women with cerebral infarction feature worse clinical profiles at admission but comparable success to men during long-term inpatient neurorehabilitation. Front Aging Neurosci.2021;13:663215. doi:10.3389/fnagi.2021.663215
- Ahmadi J, et al. Sex differences in long-term quality of life among survivors after stroke. Stroke. 2018;49:1171–1179. doi:10.1161/STROKEAHA.118.024437
- Yu AYX, Maclagan LC, Diong C, et al. Sex differences in care need and survival in patients admitted to nursing home poststroke. Can J Neurol Sci. 2020;47(2):153–159.
- Branyan TE, Sohrabji F. Sex differences in stroke comorbidities. Exp Neurol. 2020;332:113384. doi:10.1016/j.expneurol.2020.113384
Oakland University William Beaumont School of Medicine
- Functional recovery remains a major challenge for stroke survivors, despite improved survival.
- Women experience worse outcomes, slower recovery, and lower long-term quality of life.
- Gender differences in recovery are underrecognized and need more research.
- Sex-specific analyses in clinical trials and targeted rehabilitation addressing hormonal and social factors may improve recovery and reduce long-term disability.