Sex Differences in Parkinson’s
Beyond the commonly known symptoms of Parkinson’s lies a complex interplay between the disease and biological sex. Research indicates that Parkinson’s disease (PD) manifests differently in men and women, influencing symptoms, medication side effects and treatment outcomes (Cerri et al., 2019). Some of these differences may be due to biological factors, while others could be attributed to issues such as lack of access to quality healthcare, or unconscious gender biases of healthcare professionals (Parkinson's Foundation, n.d.-b).
Symptomatic Variations
A person’s sex influences the clinical presentation of Parkinson’s disease. However, with symptoms varying widely among individuals, it becomes challenging to ascertain sex-specific differences. Women face greater hurdles in obtaining an accurate diagnosis, often downplaying their symptoms, which complicates efforts to identify sex-related symptom disparities (Parkinson's Foundation, n.d.-a).
Research indicates that women typically present symptoms and receive a diagnosis of Parkinson's disease approximately two years later than men (Seladi-Schulman, 2023). Furthermore, women may experience delayed onset of motor complications and a prolonged time to reach advanced disease stages. Tremors are commonly reported as the initial symptom in women, followed by a gradual decline in motor function, while men often initially present with slow or rigid movements, known as bradykinesia (Parkinson's Foundation, n.d.-a).
Men with PD are more prone to developing walking problems characterized by freezing of gait, while women face a higher risk of falls as the disease progresses (Seladi-Schulman, 2023). Additionally, symptoms such as fatigue, restless legs, constipation, pain, loss of taste or smell, weight changes, urinary dysfunction, and excessive sweating are reported to be more severe and prevalent in women with Parkinson's disease (Seladi-Schulman, 2023).
Recent epidemiological studies consistently show that women are diagnosed with Parkinson's disease at half the rate of men, yet the underlying reasons for this discrepancy remain unclear. Despite the lower rate of diagnosis, women with Parkinson's disease tend to experience worse outcomes in terms of mortality and disease progression compared to men (Cerri et al., 2019).
Non-Motor Symptoms and Mental Health
Disparities between sexes in Parkinson's disease extend beyond motor symptoms to encompass non-motor manifestations. While cognitive impairment is common, men may be more susceptible to certain cognitive deficits compared to women. Notably, executive dysfunction, characterized by difficulties with planning, organizing, and problem-solving, appears to be particularly prevalent in men with Parkinson's disease, significantly impacting their daily functioning (Seladi-Schulman, 2023). Moreover, research suggests that men with PD may experience more pronounced declines in visuospatial abilities and attention compared to women, highlighting the importance of early detection and targeted cognitive interventions (Seladi-Schulman, 2023).
Conversely, women with Parkinson's disease report a higher prevalence of mood changes, anxiety, and depression compared to men (Dolhun, 2023). This disparity may be influenced by various factors, including biological differences, hormonal fluctuations, and psychosocial factors. Societal expectations and gender norms may further contribute to the higher prevalence of anxiety and depression in women with PD. Women are often socialized to be more expressive and emotionally open, which may lead them to seek help for mental health concerns more readily than men. In contrast, men may feel pressure to conform to traditional masculine norms, such as stoicism and self-reliance, which can create barriers to seeking support and expressing vulnerability.
Implications and Management Strategies
Studies have shown that women with PD experience significantly less social support, higher levels of psychological distress, and report worse health-related quality of life during initial care visits compared to men (Cerri et al., 2019). The lower levels of social support observed in women with PD may contribute to increased psychological distress and poorer quality of life. Social support plays a vital role in helping individuals cope with the challenges of PD, providing emotional, practical, and informational assistance. This also impacts men as their reluctance to seek help for mental health issues in the context of PD has important implications for disease management and overall well-being. Untreated depression and anxiety can exacerbate motor symptoms, impair cognitive function, and negatively affect medication adherence and quality of life.
The impact of psychological distress in both men and women sheds light on the need to address mental health in disease management. These findings also underscore the importance of both men and women finding a support system that works for them, whether it be through support groups, mental health professionals, or a circle of supportive friends. Ultimately, fostering a supportive environment and providing access to mental health services is crucial for improving outcomes and enhancing the quality of life for individuals living with Parkinson's disease, regardless of one’s sex.
Understanding the symptomatic differences between men and women with Parkinson's disease is essential for providing tailored and effective care. By recognizing and addressing these variations, healthcare professionals can optimize treatment outcomes and improve the quality of life for individuals living with PD, irrespective of biological sex.
Treatment and Management
The dynamics of PD care further accentuate the disparities between men and women. Women with PD often face unique challenges; they are more likely to attend appointments alone, lack a carepartner, and live alone (Parkinson's Foundation, n.d.-a). This emphasizes the necessity for customized care programs aimed at fostering inclusivity and comfort for women, thereby ensuring equal access to care and sufficient support to enhance their well-being and quality of life.
One of the critical aspects of PD management is pharmacological therapy, primarily using levodopa, dopamine agonists, and other medications to alleviate symptoms. However, studies have shown that women with PD may exhibit differences in treatment response compared to men. Levodopa, the primary medication used to manage Parkinson's symptoms, may have different pharmacokinetic profiles in men and women due to variations in body composition and hormonal influences (Haaxma et al., 2007). It tends to accumulate more in women's bodies due to their lower average weight, leading to increased side effects like dyskinesia and fluctuations in medication effectiveness (Parkinson's Foundation, n.d.-b). For instance, wearing off (WO), a complication where PD symptoms re-emerge before the next dose of levodopa, is reported to be more prevalent in women. Research indicates that women with PD have an 80% increased risk of experiencing wearing-off compared to men, affecting both motor and nonmotor symptom scores (Crispino et al., 2020). This poses a challenge for physicians in finetuning Parkinson’s medications for women as they frequently encounter significant symptom fluctuations with minor adjustments in medications or schedules (Parkinson's Foundation, n.d.- a).
Deep Brain Stimulation (DBS) and Gender
Deep Brain Stimulation (DBS) is another important treatment option for individuals with advanced PD. However, research suggests that women may have different responses to DBS compared to men. Despite reporting greater improvements in quality-of-life post-surgery, women are less likely to undergo DBS compared to men (Parkinson's Foundation, n.d.-a). This disparity in access to DBS highlights the need to address systemic barriers and biases in healthcare delivery. Women face additional challenges in accessing specialized care and support services for PD, contributing to delayed diagnosis and suboptimal symptom management (Parkinson's Foundation, n.d.-a).
To address these disparities, it is crucial to promote approaches specific to one’s sex in managing and treating Parkinson's disease (PD). Healthcare professionals must be cognizant of the distinct clinical characteristics and treatment responses observed among men and women with PD, tailoring interventions accordingly. Moreover, efforts to enhance inclusivity in research and clinical trials are imperative to gather sex-specific data and formulate evidence-based guidelines for PD management. By tackling these issues, we can strive towards ensuring equitable access to care and better outcomes for all individuals living with PD, irrespective of sex.
Sex significantly impacts the management of Parkinson's, evident in differences in symptom presentation, treatment responses, and access to care. A deeper understanding of these disparities can lead to earlier detection, more effective symptom management, and an improved quality of life, especially for women grappling with the disease. By shedding light on the unique challenges faced by men and women with Parkinson's, we encourage this community to advocate for themselves in every way ensuring their voices are heard and needs are met in their journey with the disease.
Sources
Cerri, S., Mus, L., & Blandini, F. (2019). Parkinson’s Disease in Women and Men: What’s the Difference? Journal of Parkinson’s Disease, 9(3), 501–515. https://doi.org/10.3233/jpd191683
Crispino, P., Gino, M., Barbagelata, E., Ciarambino, T., Politi, C., Ambrosino, I., Ragusa, R., Marranzano, M., Biondi, A., & Vacante, M. (2020). Gender Differences and Quality of Life in Parkinson’s Disease. International Journal of Environmental Research and Public Health, 18(1), 198. https://doi.org/10.3390/ijerph18010198
Dolhun, R. (2023, May 12). Ask the MD: Being a Woman + Having Parkinson’s = Unique Experiences. www.michaeljfox.org; The Michael J. Fox Foundation. https://www.michaeljfox.org/news/ask-md-being-woman-having-parkinsons-uniqueexperiences
Parkinson's Europe. (n.d.). Women and Parkinson’s. www.parkinsonseurope.org; Parkinson’s Europe. https://www.parkinsonseurope.org/living-well/wellbeing/personalhealth/women-and-parkinsons/
Parkinson's Foundation. (n.d.-a). Women & Parkinson’s (Dr. Mara. Seier, Ed.). www.parkinson.org; Parkinson’s Foundation. Retrieved February 2024, from https://www.parkinson.org/living-with-parkinsons/finding-care/women
Parkinson's Foundation. (n.d.-b). Women and PD. www.parkinson.org; Parkinson’s Foundation. Retrieved February 2024, from https://www.parkinson.org/library/factsheets/women#:~:text=Key%20Facts
Seladi-Schulman, J. (2023, June). How Does Parkinson’s Disease Affect Women? Healthline. https://www.healthline.com/health/parkinsons-symptoms-men-women
This content was published in the March 2024 edition of our monthly support group newsletter, GroupLink. The content was accurate as of this publication date.