Review Highlights Sex-related Differences In Parkinson’s

sex-related differences

Parkinson’s disease (PD) is more common among males, but it tends to progress faster in females. This and other sex-based differences in the neurodegenerative disease were highlighted in a recent review, titled “Parkinson’s Disease in Women and Men: What’s the Difference?” and published in the Journal of Parkinson’s Disease.

The review explains the current state of scientific understanding of how Parkinson’s differs among the biological sexes in a number of regards.

The first of these is motor symptoms, which emerge later in females.

Females are more likely to have tremors as their first presenting symptom, to develop unstable postures, to have reduced rigidity, and to progress to falling. Males, on the other hand, are more likely to develop later gait freezing, and have a higher risk of developing camptocormia — an abnormal flexing of the trunk. An ongoing clinical trial (NCT03573232), sponsored by the Università di Verona in Italy, is evaluating the impact of biological sex on other postural abnormalities.

Non-motor symptoms differ between the sexes as well. Symptoms including fatigue, depression, constipation, pain, excessive sweating, fluctuations in weight, difficulty swallowing, and loss of taste or smell are more common in females, whereas males are more likely to experience cognitive impairment and impulse control disorders, for example, pathological gambling.

Beyond the manifestation of symptoms, the review notes that the mechanisms that cause PD likely differ based on sex. This includes factors ranging from different genes that may be more or less impactful in different sexes, to distinctions in the role of inflammation, to differences in brain cells themselves.

In particular, the review authors highlight the role of sex-related hormones — most notably estrogens — in the development of Parkinson’s.

“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 sex-related behavior and functions,” Silvia Cerri, PhD, the head of the laboratory of cellular and molecular neurobiology of the IRCCS Mondino Foundation and co-author of the review, said in a press release.

“Neuroinflammation is an important piece of the pathogenic puzzle of PD,” Cerri added. “Since estrogens have anti-inflammatory properties, their actions throughout the lifespan could partially account for sex-related risk and manifestation of PD.”

Despite these many findings, research into sex-based differences in Parkinson’s is only just beginning to yield clear answers.

“We are still far away from the actual understanding of what underlies such [sex-based] differences,” the researchers said. “Studies in this area are under-represented, both from the clinical and research perspective, especially for females.”

The review’s investigators hope that, by drawing attention to these differences, they can encourage further research in the field. This could have utility not just in understanding how the disease manifests in distinct ways in different people, but also in providing the best possible individualized treatment.

“It is a line that is worth pursuing and will deserve further attention by the scientific community and policy makers,” the authors concluded.

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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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Non-Motor Symptoms Different Among Men and Women, Study Shows

non-motor symptoms

Non-motor symptoms (NMS) in Parkinson’s disease are significantly more frequent and differ between men and women, a new study shows.

The study, “Frequency of non-motor symptoms in Parkinson’s disease presenting to tertiary care centre in Pakistan: an observational, cross-sectional study,” was published in the journal BMJ Open.

Parkinson’s NMS include anxiety, depression, dementia, psychosis, sleep impairment, pain, fatigue, constipation, and sexual dysfunction.

Although NMS are common and most of them treatable, some, such as bowel incontinence or sexual dysfunction, may be under-reported due to embarrassment or lack of awareness that they may be associated with Parkinson’s. Prior research in the U.S. has indicated that phsysicians failed to recognize anxiety, depression and fatigue in more than half of encounters with patients.

To determine the frequency of non-motor symptoms in Parkinson’s patients, researchers used the 30-item NMS questionnaire, which is intended to empower patients and caregivers to report relevant NMS not otherwise discussed in routine clinical visits.

This questionnaire has been independently validated and is recommended by the U.K.’s Department of Health for use in clinical practice.

The study included 85 adult Parkinson’s patients who came to a movement disorder clinic at a tertiary care center in Lahore, Pakistan. The team evaluated NMS’ pattern and analyzed potential differences between men and women.

Results revealed a mean of nearly seven different NMS per patient. Constipation (56%) and nocturia (frequent urination at night, 49%) were the most common NMS, while 35% of patients reported urinary urgency.

As for neuropsychiatric complications, 47% of patients reported low mood and sadness, while 36% reported anxiety/panic, and 45% short-term memory impairment.

Light-headedness and dizziness were reported by 40%, sexual dysfuntion by 30%, difficulty falling asleep by 29%, pain unrelated to the musculoskeletal system by 30%, and loss or change in the ability to taste or smell by 29%. All other NMS, including daytime sleepiness, were under 25% in frequency.

Regarding sex differences, feeling sad or blue, light-headededness and dizziness, unexplained pain, unpleasant sensations in the legs while at rest, difficulty in swallowing, and faecal incontinence were the most frequently reported NMS in women; men reported constipation, nocturia, and problems with memory more often.

Male patients reported sexual dysfunction more frequently than women, which the authors attribute to women in Pakistan being uncomfortable with discussing intimate issues.

Among the study’s limitations, the scientists mentioned the low number of women (15), which they hypothesize may be due to men seeking medical care more often.

“In this study we have shown the high frequency of NMS in patients with [Parkinson’s] in Pakistan … Certain NMS are more common in women as compared with men,” researchers wrote, adding that the findings warrant large-scale study to assess the sex-specific incidence of NMS in Parkinson’s patients.

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Source: Parkinson's News Today