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Disease Complications and Healthcare Use More Common in Women Than Men, Dutch Study Finds

gender differences

Women with Parkinson’s are more likely than men to have disease-related complications within five years of diagnosis and more likely to access healthcare services sooner, findings from a Dutch study suggest.

The study, “Sex-Specific Patient Journeys in Early Parkinson’s Disease in the Netherlands,” was published in Frontiers in Neurology.

Throughout their disease’s course, Parkinson’s patients need to rely on various healthcare providers, from general practitioners to therapists and neurologists, to maintain a quality of life.

“This ‘journey through the healthcare system’ varies per individual because of heterogeneity of symptoms, differences in disease progression rate, and the occurrence of PD-related complications. One important source of this variation might be sex differences in the presentation of PD [Parkinson’s disease],” the researchers wrote.

Evidence indicates that Parkinson’s affects more men than women, and that the disease starts at earlier ages and progresses faster in men. Women are known to have more tremor-dominant Parkinson’s, while men most often experience the akinetic-rigid kind — that typified by a slowness of movement, accompanied by muscle stiffness, postural instability and gait difficulties.

Nonetheless, it remains to be understood if these sex differences translate into “patient journeys” distinct to Parkinson’s. Knowing these journeys can help to improve access to services, and enhance coordination and quality of care.

Medical data today are routinely collected and stored in administrative healthcare databases, and typically cover both a patient’s health status and healthcare-related services. Such information can be found through electronic health records, medical claims, and drug and disease registries.

Investigators at Radboud University Medical Center used national medical claims data to reconstruct the sex-specific journey of Dutch Parkinson’s patients over the first five years after a diagnosis. (The study notes that the Netherland has “compulsory health insurance … [and] comparatively low out-of-pocket payments.”)

The claims database chosen for analysis contained data of all people diagnosed with Parkinson’s disease between 2012 and 2016 in the Netherlands. Researchers analyzed the time it took for patients to receive care from neurologists, allied healthcare therapists, or primary care physicians. They also studied the occurrence of Parkinson’s-related hospitalizations, incidences of pneumonia, orthopedic injuries, enrollment in a nursing home, and death.

In total, 22,293 medical claims regarding early Parkinson’s were analyzed: 13,518 (60.6%) involving male patients and 8,775 (39.4%) for females. At the time of diagnosis, men had a mean age of 71.6 years, and women 72.5.

The first Parkinson’s-related complications, such as pneumonia, orthopedic injuries, and hospitalization, began to be reported at a median of 1.8 years for women and 2.3 years for men.

Five years post-diagnosis, 68.7% of the men had at least one Parkinson’s disease-related complication, 22.5% lived in a nursing home, and 18.3% had died. Among the women, a greater percentage had at least one Parkinson’s complication ( 73%) and lived in a nursing home (27.2%), but a lesser percentage (14.6%) had died.

Female patients were more likely to visit their general practitioners earlier and more often than did male patients, starting about one month after diagnosis. Women began to doctor visits 31 days post-diagnosis and returned for checks-ups ever six weeks, men made a first visit at 41 days post-diagnosis and returned every eight to nine weeks.

Women also started their physiotherapy treatment earlier and returned more often: five months after diagnosis and once every five to six weeks thereafter; among men, physiotherapy started at eight months and continued once every seven to eight weeks.

“After 5 years, 37.9% … of women had visited an occupational therapist and 18.5% … a speech and language therapist at least once,” compared to 33.1% and 23.7%, respectively, for men, the researchers wrote. These differences were statistically significant.

Overall, gender differences among Parkinson’s patients were found to be related not only disease manifestations or progression, but also with the use of healthcare services.

“[O]ur findings suggest that women experience complications and access most healthcare services sooner after diagnosis and more frequently than men,” the researchers wrote.

“We hope these insights can lead to better and more personalized care for [Parkinson’s disease] patients of both sexes,” they concluded.

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Women with Parkinson’s Who are Homebound Face Greater Barriers to Access Support, Study Finds

homebound women

Women with advanced Parkinson’s disease who are homebound are more likely to live alone and may face greater barriers to accessing support.

That finding comes from the study, “Sex-related differences in homebound advanced Parkinson’s disease patients,” which was published in Clinical Interventions in Aging.

Parkinson’s motor and non-motor symptoms negatively affect patients’ quality of life. Caregivers play an important role in keeping Parkinson’s patients engaged in daily activities, which can improve their quality of life.

“The combination of advanced PD [Parkinson’s disease], older age, and its associated accumulation of comorbidities are negatively reinforcing, rendering many people homebound. Once homebound and disconnected from routine care, this population is at further risk of deterioration and adverse events,” the researchers wrote.

Parkinson’s duration appears to be similar between the sexes. However, and in comparison to men, studies indicate that women tend to be older, have greater disease severity, other diseases aside from Parkinson’s (comorbidities), and are less likely to be monitored by a neurologist or receive surgical interventions like deep brain stimulation.

A recent study also has shown that women are at greater risk of having poor access to caregivers.

To further explore the associations between sex, homebound status and access to care, researchers studied the characteristics of men and women who were unable to leave their home and who were enrolled in a home visitation program for people with advanced Parkinson’s and related disorders. The study was a collaboration among nine institutions, including universities and medical centers.

Patients were seen between February 2014 and July 2016. Researchers analyzed the subjects’ data, which was either collected through in-person interviews or medical chart review.

Of the 85 enrolled patients, 52% (44 people) were women. At the first program-related home visit, individuals had an average age of 79.6 years and no differences were found between sexes.

Among the women, 32 had Parkinson’s disease, eight had dementia with Lewy bodies, one had Parkinson’s disease dementia, and the remaining nine had different types of parkinsonism-like disorders.

Overall, in the entire group of 85 patients, Parkinson’s was the most common diagnosis (79%). A diagnosis of Parkinson’s dementia was more frequent in men (17.1%) than in women (2.3%).

Men were found to have greater caregiving assistance, compared to women. “Comparing caregiver types, 70.7% of men identified a spouse, partner, or significant other serving as a caregiver compared to only 27.3% of women,” the researchers noted.

Women were more frequently single or widowed, which could be explained by the fact that women have a longer life expectancy than men.

About 18.1% of women lived alone and had no caregiver, compared to 2.4% in the male subsample.

“This study highlights the relative lack of caregivers among homebound women with advanced PD [Parkinson’s disease] and emphasizes the vulnerability of this group of patients to interruptions in continuity of care. With additional understanding of barriers to care, clinicians can further individualize treatment strategies, counseling, and care planning based on these sex-related differences,” the researchers concluded.

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Lifetime Risk of Developing Parkinson’s Similar Between Women and Men, Study Reports

lifetime risk

One in two women and one in three men older than 45 will develop Parkinson’s disease, dementia or stroke during their lifetime, a new study suggests.

Preventive strategies to delay disease onset can reduce this risk by up to half.

The study with those findings, “Lifetime risk of common neurological diseases in the elderly population” was published in the Journal of Neurology, Neurosurgery & Psychiatry.

Parkinson’s disease, dementia and stroke are among the leading causes of mortality and disability in older individuals. In fact, the diseases often co-occur. Parkinson’s disease and stroke patients are at increased risk of dementia, and patients with dementia at increased risk of stroke.

Researchers from the University Medical Center Rotterdam, The Netherlands, assessed the lifetime risk for dementia, stroke and parkinsonism in middle-aged and elderly men and women between 1990 and 2016.

They followed 12,102 individuals (57.7% women) aged 45 or older who were free from these diseases at baseline (beginning), and enrolled in the Rotterdam Study, a prospective population-based group. Participants participated in full medical check-ups every four years.

After 26-years of follow-up, 1,489 individuals were diagnosed with dementia, 1,285 with stroke, and 263 with Parkinson’s disease. A total of 438 individuals were diagnosed with more than one disease.

The overall lifetime risk to develop any of these conditions for a 45-year-old was 48.2% in women and 36.3% in men.

This difference was due to a higher risk of dementia as the first manifesting disease in women rather than men (25.9% vs 13.7%, respectively), while the risk for stroke (19.0% vs 18.9%) and parkinsonism (3.3% vs 3.6%) was similar between the sexes.

Moreover, this risk increased with age – between the ages of 45 to 65 years this risk ranged from 2.6% for women and 3.2% for men. After that, and until the age of 95, up to 45.8% of women and 35.3% of men were at risk.

“At age 45, first manifestation of stroke posed the highest lifetime risk for men (18.9%). Dementia posed the largest risk for women (25.9%), which was significantly higher compared with that for men (13.7%),” researchers wrote.

The lifetime risk for Parkinson’s was similar between women (4.3%)  and men (4.9%).

Strategies that delay disease onset between one to three years could reduce the lifetime risk for developing any of these diseases by 20% in individuals 45 and older, and by more then 50% in the oldest members of that group.

“Even a delay in onset for a few years of only one disease could already result in substantial reductions for the combined lifetime risk of developing any of these diseases,” researchers wrote.

“These findings strengthen the call for prioritizing the focus on preventive interventions at population level which could substantially reduce the burden of common neurological diseases in the aging population,” they concluded.

The post Lifetime Risk of Developing Parkinson’s Similar Between Women and Men, Study Reports appeared first on Parkinson’s News Today.

Lack of Exercise Increases Parkinson’s Risk in Men, Review Study Confirms

Men who lack physical activity have a higher risk of developing Parkinson’s disease at some point in their lives, a systematic review has found. Importantly, findings revealed that even moderate exercise can be enough to counteract this effect.
The review, “Association of Levels of Physical Activity With Risk of Parkinson Disease,” was published in JAMA Network Open.
Parkinson’s disease, the second most prevalent neurodegenerative disease of the elderly (after Alzheimer’s disease), is characterized by the gradual loss of muscle control, sometimes accompanied by cognitive deficits.
The underlying causes of Parkinson’s disease are still poorly understood by scientists, but likely involve a combination of genetic and environmental risk factors. In the past 20 years, several prospective studies have focused on the effect of lifestyle factors, such as exercise, on Parkinson’s.
Although physical activity is known to decrease the risk of developing several conditions, including cardiovascular disease, stroke and diabetes, systematic studies addressing the impact of physical activity on Parkinson’s risk are few in number and often inconsistent regarding their methodology and data interpretation.
This systematic review focused on gathering data from previously published prospective studies to quantify the dose-response association between physical activity and Parkinson’s risk.
Following an initial period of literature research performed by two independent investigators, a total of eight prospective studies involving 544,336 participants — including 2,192 Parkinson’s patients with a median follow-up period of 12 years — focused on the relationship between physical activity and Parkinson’s risk, were included in the review.
Pooled data from all the studies showed that participants included in the highest category of total physical activity had a 29% lower risk of developing Parkinson’s compared to those who did not engage in any moderate-to-vigorous physical activity. Conversely, light physical activity was not linked to Parkinson’s risk.
Further subgroup analyses revealed that the relationship between physical activity and Parkinson’s risk was not influenced by geographic region, follow-up duration, population size, or study quality. They were  affected, however, by gender, as the link between exercise and Parkinson’s risk was more robust among men, regardless of physical activity levels, compared to women.
Finally, the dose-response analysis showed that for each increase of 10 metabolic equivalents of task (MET) — a method to measure the energy cost of physical activities — of hours per week in total or moderate-to-vigorous physical activity, Parkinson’srisk in men decreased by 10% and 17%, respectively. This dose-response effect was not observed among women.
“[O]ur pooled analysis of more than half a million adults revealed that higher levels of physical activity —particularly moderate to vigorous activity — are associated with a lower risk of developing PD [Parkinson’s disease]. These benefits were significant among men, but were less robust among women,” researchers wrote.
“These findings may help guide physicians and health care policy makers in making recommendations and developing guidelines with respect to the degree of physical activity that can help reduce the risk of PD at both the individual level and the population level. More epidemiological studies with large sample size and detailed quantification of physical activity will help establish more precise information regarding this association,” they concluded.
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