Parkinsons Strikes More Men Than Women Researchers Have Worked For Decades To Learn Why
J. William Langston, who has been studying and treating Parkinsons disease for nearly 40 years, always has found it striking that so many more men than women show up in his clinic. His observation is not anecdotal. It is grounded in science and shared by many physicians: Men are roughly 1.5 times more likely than women to develop Parkinsons, a progressive disorder of the nervous system that impairs movement and can erode mental acuity.
Its a big difference that is quite real, says Langston, clinical professor of neurology, neuroscience and of pathology at the Stanford University School of Medicine and associate director of the Stanford Udall Center. Its pretty dramatic. I think anyone who sees a lot of Parkinsons will tell you that.
While the disproportionate impact is clear, the reasons for it are not. Its a great mystery, Langston says. Researchers still dont know what it is that makes men more susceptible to Parkinsons, or what it is about women that may protect them or both. But they are trying to find out.
Parkinsons results from the death of key neurons in the substantia nigra region of the brain that produce the chemical messenger dopamine. Over time, the loss of these nerve cells disrupts movement, diminishes cognition, and can cause other symptoms, such as slurred speech and depression.
Such a Parkinsons study could do the same, she says.
Why Parkinsons Disease Occurs More Commonly In Men Than Women
Parkinsons disease is a progressive neurological disorder, the symptoms of which include tremors, stiffness, and slow or hesitant speech. It typically develops gradually over time resulting from a deficiency in the brain of dopamine, an important chemical that permits nerve cells to communicate with each other. Every year, an estimated 60,000 Americans are diagnosed with Parkinsons disease, and men are 1.5 times more likely to have Parkinsons disease than women.
Researchers have been investigating various studies on the incidence and prevalence of Parkinsons disease in the population and found that the risk of developing Parkinsons disease is greater in men than women. These studies offer new clues to how the disorder affects men and women differently and shed light on why men are more susceptible to the disease.
Farmers and Other Agricultural Workers Have an Increased Risk of Getting Parkinsons Disease, Studies Say
In the United States, we enjoy abundantly, affordable produce year-round, yet, few realize where that food comes from and who grows it. Each year, 3 million about two million family farmworkers and another one million hired farmworkers labor in fields across the country to bring us fresh fruits, vegetables, and other agricultural products.
Pesticide Use Is a Joint Result of Information and Farmers Trust
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Men Face Higher Risk Of Parkinson’s
Researchers say previous studies on death rates from Parkinson’s disease have shown that men might suffer disproportionately from the condition. But they say death rates aren’t an accurate indicator of the disease because they don’t include the number of new cases and the cause of death isn’t always confirmed.
In this study, researchers analyzed studies on the incidence of Parkinson’s disease among populations in the U.S., China, Poland, Italy, Spain, and Finland. The incidence of a disease reflects the number of new cases developed or diagnosed during a specific time period within a certain population.
After adjusting for age, the analysis showed that men were 1.5 times more likely to develop Parkinson’s disease than women.
The results appear in the April issue of the Journal of Neurology Neurosurgery and Psychiatry.
Researchers say the male gender itself may be a risk factor for Parkinson’s disease, or it may just be a marker for other risk factors that men are exposed to more than women, such as working with toxic chemicals or head injuries, which have been associated with higher risks of the disease.
Another explanation may be that estrogen may have a protective effect on the female nervous system.
Whatever the reasons behind the increased risk of Parkinson’s disease among men, researchers say learning more about them may yield new clues about how the mysterious disease develops.
Journal of Neurology Neurosurgery and Psychiatry
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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 .
What Is Parkinsons Disease
Parkinsons is named after Dr James Parkinson, a London doctor who first described the disease as a shaking palsy in 1817. It is a chronic, neurodegenerative disease – the illness affects the nerve cells in the brain that control movement. Parkinsons progressive. Its symptoms appear gradually, and they slowly get worse.
According to one estimate, 1-2 out of every 1,000 people are living with Parkinsons disease worldwide. India has a relatively low incidence of the disease , except in the Parsi community of Mumbai .
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Symptoms Of Parkinsons Disease In Women
- Tremor of the hands, arms, legs, or face
- Rigidity of the limbs and trunk
- Slowness of movement
- Difficulties with urination or constipation
Although PD symptoms are highly individual, some studies have found small differences in how symptoms appear in women versus men.
One study from the Netherlands found that women experienced more tremor than men .6 Some small studies suggest that women score better on tests for motor abilities and mental processes than men. Women are also more likely to have depression and to report problems with daily living, cardiovascular disease, and fatigue. Men experience higher rates of sleep disorders than women.3
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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Is Parkinsons Disease Inherited
Scientists have discovered gene mutations that are associated with Parkinsons disease.
There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.
Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.
Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.
Causes Of Parkinson’s Disease
Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.
Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.
Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.
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Sry And Parkinsons Disease
In humans and other mammals, females have two X chromosomes , and males a single X and a male-specific Y chromosome . SRY is the master gene on the Y chromosome that determines the male sex of a baby in the embryo.
But research has found SRY seems to be active in other parts of the body, too. In mice and rats, SRY is active in the brain, and in humans itâs expressed in several tissues and organs, including the brain.
SRY has been found to be expressed at abnormally high levels in the brains of mice and rats mutated to have symptoms of Parkinsonâs disease, and in animals where the disease was induced by chemical treatment.
Previous work showed overactivity of the SRY gene destroys neurons that synthesize dopamine. Weâre not entirely sure how this happens, but given the link between dopamine production and Parkinsonâs disease, it might partly explain why Parkinsonâs disease affects males more commonly than females.
This new study now shows that interfering with SRY expression in the brains of rodents with Parkinsonâs disease ameliorates the severity of symptoms. Vince Harley and Joohyung Lee from the Hudson Institute in Melbourne found that quashing SRY action prevented or mitigated the reduced mobility of male animals with Parkinsonâs disease.
So, suppressing the activity of SRY in neurons of Parkinsonâs disease patients could ameliorate their symptoms.
Conditions That Affect Men More Than Women
Polycystic ovary syndrome only affects women. Prostate cancer only affects men.
Now lets put aside certain sex-specific health conditions and diseases.
For all other diseases that can affect individuals of both sexes, it is important to realize that some conditions can be sex-biased, meaning that the rate of occurrence is more prevalent in one sex versus the other.
Thats right, some diseases you are at a higher risk for given the pairing of your sex chromosomes.
Our experts at Hackensack Meridian Health Medical Group outline some of the most common conditions affecting more men than women:
Abdominal aortic aneurysm .
What is AAA?
David Armstrong, D.O., board certified in internal medicine and cardiovascular disease, explains that an AAA is an abnormal enlargement of the abdominal portion of the aorta, which runs from your heart through the center of your chest and abdomen.
As the largest blood vessel in the body, the aorta supplies blood to the body. Normally, the abdominal aorta is about 2 cm in diameter, whereas an AAA is 1.5 times that sizeor at least 3 cm. Over time, an AAA can rupture or burst and cause life-threatening complications.
Men are 4-15 times more likely to develop an AAA than women, notes Dr. Armstrong. Research is still ongoing as to why fewer incidents of AAAs are seen in women, he says. One hypothesis is that there may be a protective effect of estrogen on certain cells that make up the wall of the aorta.
What are the symptoms?
How to prevent it:
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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.
Environmental Factors And Exposures
Exposure to pesticides and a history of head injury have each been linked with PD, but the risks are modest. Never having smoked cigarettes, and never drinking caffeinated beverages, are also associated with small increases in risk of developing PD.
Low concentrations of urate in the blood is associated with an increased risk of PD.
Different medical drugs have been implicated in cases of parkinsonism. Drug-induced parkinsonism is normally reversible by stopping the offending agent. Drugs include:
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Other Studies Of Interest
Three high-quality papers were found but not included in the meta-analysis as they did not report age- and gender-specific incidence rates or proportions. These studies provided information on Asian and Eastern European populations that were not well represented in the meta-analysis.
Das et al. was the only study that examined PD in a south Asian Indian population, reporting average annual incidence rates for males and females in different age categories. AAIRs peaked earlier for males, than females. Male AAIRs peaked at 60-69 years female AAIRs continued to rise in 70-79 years before dropping off in the 80+ age group. Hristova et al. and Kyrozis et al. both provided incidence rates not stratified by gender and age and therefore could not be included in the meta-analysis. Both represented unique European populations and found peak incidence between 70 and 80 years.
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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Study Examines Proteins Roles In Mitochondrial Recycling
If that were the case, it would be expected that a longer time spent between menarche and menopause would be associated with a lower risk of Parkinsons, because estrogen levels tend to be higher during the time of life when a woman is regularly menstruating.
Demonstrating this in scientific studies is difficult, however. This is partly because the factors governing both hormone levels and Parkinsons risk are complex, and vary markedly person-to-person. Research on the age at menarche and menopause also is complicated by the fact that it often relies on self-reported data, which is prone to inaccuracies because life is messy and memory is fallible.
To circumvent these issues, a team led by scientists at the University of California, Los Angeles, used an approach called Mendelian randomization . This kind of analysis relies on the fact that some genetic variants are associated with traits specifically here, people with certain genetic variants tend to undergo menopause at earlier or later ages.
While these variants arent enough to determine the age at menopause for any person, in a very large population, researchers can use these variants to create groups of individuals who will tend to undergo menopause earlier, and those who will tend to undergo it later, and then make comparisons.
Further analyses indicated that, for every increased year of age at menopause, the risk of Parkinsons decreased by roughly 7% among females.
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