Gender Differences In Parkinsons Disease
Summary: Not only do women appear to be better protected against the effects of Parkinsons disease, a new study reveals a gender specific pathology exists in women with the disease as soon as the symptoms appear.The women with Parkinsons disease also exhibited better preserved short interval intracortical inhibition in both hemispheres compared to affected men and tended to have a better response to the PAS protocol on the side less affected by symptoms. NeuroscienceNews.com image is in the public domain.
Gender Differences In Cognition
Studies of cognitive changes in PD have focused on patients without dementia and have mainly cited the involvement of the basal ganglia , prefrontal cortex , fronto-striatal regions or cortico-striatal regions . Aspects of cognition often associated with these regions in PD include executive function contributing to ADLs, attention, verbal recall, and visuospatial cognition. Cognitive differences between men and women with PD have been largely unexamined. One area of focus has been the comparison in quality of life and ADLs between men and women, functions that require intact cognitive abilities.
Riedel and colleagues tested 873 PD patients . Women were more likely than men to be depressed but there was no mention of using depression as a covariate in analyzing cognitive performance. Participants were assessed with the Mini-Mental State Examination , a brief measure of overall mental status the Clock Drawing Test , and the Parkinson Neuropsychometric Dementia Assessment , a measure including five subscales of cognition commonly affected in PD . Though there were no differences on the MMSE or PANDA total score, women attained significantly worse scores than men across stages of motor severity. Because the MMSE and PANDA-total were measures of overall cognitive status and the results were not compared to a control group, the investigators were limited in their interpretation of specific cognitive abilities.
Gender Aspects In Lifestyle
Few differences in lifestyle between men and women with PD have been reported. In this section, we discuss two examples that highlight the potential impact of such differences on multidisciplinary care for people with PD: weight loss and physical activity.
Progressive weight loss is common among people with PD, likely due to a combination of physical inactivity , lower intake of solid foods due to oropharyngeal dysphagia and a catabolic state . A decreased intake of solid foods may result in less consumption of fresh foods and vegetables, which leads to a risk of malnutrition . Researchers in other fields consistently reported healthier food choices among women compared to men, including increased consumption of fresh fruit and vegetables and reduced consumption of processed food and alcohol . Encouragement by nutritionists of the consumption of healthy, solid, foods should consider these gender norms, as well as direct assessment of the abililty to prepare and consume foods due to disease-related physical limitations. Again, this is an area in which a gender-sensitive care intervention for people with PD could be informed by data from other fields. However, to our knowledge, no studies have examined the effectiveness of gender-sensitive approaches to nutrition among people with PD to date.
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Gender Differences In Overt Pd
The rate of decline in SPECT binding did not differ between the sexes. Most other studies show rates of decline similar to ours, although not specified for gender.,,, The results suggest that once the critical threshold of striatal dopamine depletion has been exceeded, disease progression does not differ between men and women. In other words, oestrogens may exert some form of neuroprotection in the preclinical stage of PD, or may even postpone the beginning of the degenerative process, but fail once symptoms have become clinically apparent. This idea is supported by animal work: oestrogens may protect against nigrostriatal degeneration in animal models of PD when administered prior to the insult,, but do not exert any beneficial effects when administered after nigrostriatal damage has occurred., This may help to understand the failure of oestrogen replacement therapy in slowing the progression of overt PD in women. Thus a double blind, placebo controlled study of high dose transdermal 17oestradiol in postmenopausal women with PD showed no effect on motor scores. Furthermore, a placebo controlled, randomised, double blind trial in postmenopausal women with PD found no significant effect of orally administered oestradiol on objective and subjective parkinsonian symptoms. An additional explanation could be that both orally and transdermally administered oestrogens do not lead to high enough oestrogen concentrations within the bloodbrain barrier to exert any effect at all.
Mental Faculties And Muscle Movement
PD can affect mental faculties and the senses as well as muscle control.
There is some evidence that men and women are affected differently. For instance, men appear to retain a better ability to understand spatial orientation. Women, on the other hand, retain more verbal fluency.
These types of skills are influenced not only by sex, but also by the side of PD symptoms. Left side or right side motor symptom onset reflects which side of the brain has the largest dopamine deficiency.
For instance, you might have more difficulty with muscle control on the left side of your body if you have a dopamine deficiency on the right side of your brain.
Different skills, such as spatial abilities, are more dominant on a specific side of the brain.
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Symptoms Of Parkinsons: Men Vs Women
Parkinsons disease in men and women
More men than women are diagnosed with Parkinsons disease by almost a 2 to 1 margin. Several studies support this number, including a large study in the American Journal of Epidemiology.
Usually there is a physiological reason for a difference in disease between men and women. How does being female protect against PD? And do women and men experience PD symptoms differently?
Gender Differences In Parkinsons Disease: Transcranial Magnetics Stimulation Study Of Newly Diagnosed Drug
K. Kolmancic, R. Alfonso, Z. Pirtosek, K. Bhatia, M. Kojovic
Session Time: 1:15pm-2:45pm
Location: Hall 3FG
Objective: In early Parkinsons disease , functional changes may be detected in primary motor cortex using transcranial magnetic stimulation . We hypothesised that, if pathophysiology differs between genders in PD, this will be reflected in differences of M1 TMS measurements.
Background: Demographic studies of Parkinsons disease found that women are almost twice less affected than men, implying protective effect of female sex. It is not known, once the symptoms develop, if disease course differs between genders, which would suggest differences in disease pathophysiology.
Methods: Forty newly diagnosed and untreated PD patients were assessed using Unified Parkinsons Disease Rating Scale . Motor thresholds, input/ output curve , short interval intracortical inhibition , cortical silent period and intracortical facilitation were measured over both hemispheres, corresponding to less and more affected side, using TMS. Plasticity was probed using paired associative stimulation protocol. Twenty-nine healthy participants completed testing on the dominant hemisphere, among them six were tested on both hemispheres.
References: The abstract will be presented at the 4th Congress of the European Academy of Neurology in Lisbon, from the 16th to 19th of June 2018.
To cite this abstract in AMA style:
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Parkinsons Disease In Women And Men: Whats The Difference
Article type: Review Article
Authors: Cerri, Silvia | Mus, Liudmila | Blandini, Fabio *
Affiliations: Laboratory of Cellular and Molecular Neurobiology, IRCCS Mondino Foundation, Pavia, Italy
Correspondence: Correspondence to: Dr. Fabio Blandini, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy. Tel.: +39 0382 380416 E-mail: .
Keywords: Parkinsons disease, sex, gender, risk factors, estrogens, signs and symptoms, dopaminergic neurons, neuroinflammation, oxidative stress
Journal: Journal of Parkinson’s Disease, vol. 9, no. 3, pp. 501-515, 2019
How And Why Does Parkinson’s Disease Effect Women And Men Differently
- IOS Press
- There is growing evidence that Parkinson’s disease affects women and men differently. In this insightful review, scientists present the most recent knowledge about these sex-related differences and highlight the significance of estrogens, which play an important role in the sex differences in PD.
There is growing evidence that Parkinson’s disease affects women and men differently. In this insightful review, published in the Journal of Parkinson’s Disease, scientists present the most recent knowledge about these sex-related differences and highlight the significance of estrogens, which play an important role in the sex differences in PD.
PD is a slowly progressive disorder that affects movement, muscle control, and balance. It is the second most common age-related, neurodegenerative disorder, affecting about 3% of the population by the age of 65 and up to 5% of individuals over 85 years of age. The risk of developing PD is twice as high in men than women, but women experience a more rapid disease progression and a lower survival rate.
“It is becoming increasingly evident that PD differs in women and men,” explained lead author Fabio Blandini, MD, Scientific Director of the IRCCS Mondino Foundation, National Institute of Neurology, Pavia, Italy. “Recent research findings suggest that biological sex also impacts on disease risk factors and, potentially, on molecular mechanisms involved in the pathogenesis of PD.”
Motor and non-motor symptoms
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Expressing And Interpreting Emotion
PD rigidity can cause the muscles of the face to freeze. This leads to a mask-like expression. As a result, patients with PD have difficulty expressing emotion with their faces. They also can begin to have difficulty interpreting others facial expressions.
One study suggests that both men and women with PD can have difficulty interpreting anger and surprise, and that men are more likely to lose the ability to interpret fear.
However, women may be more upset by their inability to interpret emotions. All PD patients may benefit from speech and physical therapy to help with this symptom.
Pharmacological Therapy Of Non
Antipsychotic are an important drug class for the treatment of patients with PD or dementia with Lewy bodies in cases where hallucinations and psychosis can be disabling. However, these drugs have been associated with increased mortality and morbidity in this population, especially in older PD patients. Two independent studies on Canadian cohorts of PD patients under treatment with antipsychotic drugs showed that older age and male sex were significantly associated with an increased rate of antipsychotic prescriptions during follow-up . As reported in another study, male PD patients more often receive a prescription of antipsychotic drugs in the absence of a clear psychosis diagnosis, with respect to female patients. This, as suggested by the authors, may be related to the fact that male patients are more prone to become aggressive and difficult to assist than women, when the disease is complicated by psychosis .
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Gender Aspects In Coping And Informal Care
Several differences in care management between men and women with PD have been reported. In this section, we discuss two examples that highlight the potential impact of such differences on multidisciplinary care for people with PD: coping strategies and informal care.
Gender can influence individual coping strategies and should be taken into account in systematically measuring differences in distress and coping . General studies on gender differences coping strategies are conflicting. Some authors report that women use more emotion-focused coping strategies while men prefer focusing on avoidant coping . However, a study targeting coping strategies among people with PD reported the opposite, with women reporting more problem-focused coping strategies compared to males . Interestingly, less polarized gender roles might associate with better quality of life in women. Specifically, androgynous women with PD, expressing masculine and feminine personality traits equally, scored significantly better on quality of life than androgynous men with PD . Similar to the impact of gender roles on the reponse to negative life events in the context of depression, clinicians should be aware of the potential impact of gender roles on effective coping strategies. Additionally, researchers should continue to explore the impact of different gender dimensions on coping strategies and health-related quality of life in people with PD.
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Gender Differences Of Nonmotor Symptoms Affecting Quality Of Life In Parkinson Disease
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Attention And Working Memory
WAIS-III Digit Span: This measure is divided into two separate tasks, digit span forward and digit span backwards . DSF requires the participant to verbally reproduce a given sequence of single-digit numbers. DSB requires the participant to retain and manipulate a given sequence but reproduce the sequence in reverse order. Both tasks use progressively longer sequences until the sequence can no longer be reproduced. DSF is considered a test of simple auditory attention, and DSB is considered a test of auditory working memory.
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Gender Differences In Clinical Symptom Presentation
In a larger-scale study, Scott and colleagues contrasted symptom characteristics at disease onset and later . Relative to onset, at time of second evaluation men listed more symptoms, though women reported that their symptoms caused them more distress . The investigators suggested the reporting differences may have arisen from âdifferences in social acceptance of communicating emotionality.â
Pharmacological Therapy Of Motor Symptoms
In the absence of a disease-modifying therapy, PD treatment is currently based on the control of motor symptoms by levodopa supplementation. However, long-term therapy with levodopa is associated with the development of motor complications, such as levodopa-induced-dyskinesia, wearing off and on-off phenomena. It is generally assumed that dyskinesia is associated with sustained levodopa plasma levels . Commonly, women present greater levodopa bioavailability, which is further supported by lower levodopa clearance levels . Dopamine bioavailability in the central nervous system is dependent on the activity of two catabolic enzymes: catechol-O-methyltransferase and monoamine oxidase-B , whose encoding genes are located on the chromosome 22 and X chromosome, respectively . A study that explored the relationship between MAO-B or COMT functional SNPs and levodopa therapy reported that male PD patients carrying the MAO-B G allele had a 2.84-fold increased risk of developing motor complications when treated with high doses of levodopa .
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Sex And Gender Aspects In Motor Features
PD is primarily known as a clinical syndrome described as Parkinsonism, which entails bradykinesia in combination with at least one of the following: resting tremor, rigidity, or postural instability . As the disease progresses, people with PD are prone to develop fluctuations in motor impairments related to dopaminergic therapy, as well as to freezing of gait . Several differences in motor features between men and women with PD have been reported and have been summarized elsewhere . However, the relevance of these differences for care provision to people with PD remains largely unknown.
The potential impact of sex or gender differences on multidisciplinary care for mobility impairments comes from other fields of medicine, such as recent recommendations for osteoporosis screening guidelines based on underlying sex differences . Osteoporosis predominantly affects postmenopausal females but also impacts many elderly males . Given the higher mortality of men with bone fractures, several osteoporosis, and endocrinology societies now recommend screening in all men above 65 or 70 years , but this recommendation is not routinely implemented in clinical practice .
Table 1. Considerations for sex- and gender sensitive multidisciplinary PD care.
Gender Differences As A Factor In Parkinsons
Men are from Earth, women are from Earth. Deal with it. George Carlin
You can either be a victim of the world or an adventurer in search of treasure. It all depends on how you view your life. Paulo Coelho
Précis: ~10% of Parkinsons cases are linked to familial genetic mutations whereas the vast majority of cases have an unknown cause and are labeled sporadic. Epidemiological studies have recently shown that the male sex is an adverse factor for developing the sporadic form of Parkinsons. Presented here is a brief overview that suggests female gonadal substances offer resilience to the loss of dopamine in Parkinsons.
The nigrostriatal dopaminergic neural pathway: Parkinsons begins when dopamine-producing neurons die in the substantia nigra region in the mid-brain. There are four dopamine-dependent neural pathways that originate from the substantia nigra/ventral tegmental area most likely, the nigrostriatal dopaminergic pathway has an important role in Parkinsons . The nigrostriatal dopaminergic pathway is the connection between the substantia nigra and the striatum . This pathway has an important function in supporting and regulating fine motor control .
It would be possible to describe everything scientifically, but it would make no sense it would be without meaning, as if you described a Beethoven symphony as a variation of wave pressure. Albert Einstein
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Impact Of Biological Sex On Pd Pathophysiology
The distinctive clinical features as well as the contribution of different risk factors support the idea that PD development might involve distinct pathogenetic mechanisms in male and female patients. It is clear that estrogens play a preponderant role in the sex differences in PD, providing disease protection as demonstrated by the similar incidence of the disease in men and post-menopausal women. Moreover, it is noteworthy that sex hormones act throughout the entire brain of both males and females and sex differences are now highlighted in brain regions and functions not previously considered as subjected to such differences, opening the way to a better understanding of gender-related behavior and functions.
This section presents an overview of the most recent evidence corroborating the hypothesis of a sex-related PD pathophysiology, with a special focus on the role of estrogens .