STN-DBS Leads to Similar Benefits in Men and Women with Parkinson’s, Study Finds

STN-DBS men women

Apart from physical health-related quality of life — which seemed to improve to a greater extent in males — the benefits of subthalamic nucleus deep brain stimulation (STN-DBS) on motor, cognitive, and mental function are similar in men and women with Parkinson’s disease, a study has found.

The study, “Sex differences in the short-term and long-term effects of subthalamic nucleus stimulation in Parkinson’s disease,” was published in Parkinsonism and Related Disorders.

STN-DBS is a non-destructive surgical treatment for Parkinson’s disease that involves implanting a device to stimulate targeted regions of the brain with electrical impulses generated by a battery-operated neurostimulator.

Since its implementation, STN-DBS has become an accepted and effective therapeutic option to treat motor symptoms associated with Parkinson’s. It also is used to treat other complications caused by prolonged dopaminergic treatment in advanced forms of the disease.

“There have been discussions on the influence of sex on the effect of STN-DBS in PD. Several short-term studies have suggested that overall improvements in motor and non-motor symptoms following STN-DBS are similar between male and female PD patients, whereas the short-term results on sex differences in postoperative health-related quality of life (HRQoL) are inconsistent,” the researchers said.

In this study, a team of Korean scientists set out to investigate the influence of sex on short- and long-term effects of STN-DBS in Parkinson’s.

The prospective study analyzed the medical records of 48 men and 52 women with the disease who received STN-DBS between 2005 and 2013 at the Movement Disorder Center of Seoul National University Hospital (SNUH) and were followed for at least five years.

The patients’ motor, cognitive and mental function, as well as health-related quality of life, or HRQoL, were assessed in all participants at the start of the treatment (baseline), and at one and five years of follow-up. HRQoL was assessed using the 36-Item Short Form Health Survey (SF-36), which contains physical and mental component subscores.

With the exception of the physical component of the SF-36, no differences were found between men and women in the effects of STN-DBS on any of the clinical parameters from baseline to follow-up.

STN-DBS led to significant improvements in the physical component of the SF-36 in individuals from both sexes from baseline to one year of follow-up. However, this positive effect was more pronounced among men than among women.

In addition, the researchers found that improvements in the physical component of the SF-36 from baseline to five years of follow-up were only statistically significant in men.

“In conclusion, we found that STN-DBS led to a similar degree of short-term and long-term effects on motor function, depressive and cognitive symptoms, and functional status between male and female PD patients,” the researchers said.

“Nevertheless, the physical HRQoL appears to improve to a greater extent in men over a long-term observation,” they concluded.

The researchers said further studies are warranted “to reveal the precise mechanism underlying the sex-associated differences in postoperative HRQoL, and to design an effective strategy to improve HRQoL in women undergoing STN-DBS.”

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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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Coffee Decreases Parkinson’s Tremors in Men, Study Suggests

coffee, tremors and Parkinson's

Drinking coffee may reduce tremors in Parkinson’s disease patients, but only among men, a recent study suggests.

The study, “Sex-dependent Effects of Coffee Consumption on Newly Diagnosed Parkinson’s Disease,” was published recently in the journal BMC Neurology.

There is some evidence that drinking coffee reduces the risk of developing Parkinson’s disease, but the effect of coffee on motor symptoms in people who already have been diagnosed with Parkinson’s is less clear.

In this study, researchers recruited Parkinson’s patients (137 women, 147 men) and divided them into two groups: coffee drinkers (204 people), which included anyone who drinks coffee regularly, or used to, even if they don’t anymore, and; non-coffee drinkers (80 people) who never regularly drank coffee.

Compared to the non-coffee drinkers, coffee drinkers were disproportionately younger, male, better-educated, and were younger at symptom onset. Coffee drinkers had less motor impairment, as demonstrated by lower scores on the motor section of the Unified Parkinson Disease Rating Scale (UPDRS; 19.46 vs. 22.84); this included significantly lower scores for tremor (2.48 vs. 3.64), bradykinesia (slow movement; 2.48 vs. 10.83) and gait and posture (0.78 vs. 1.16).

Of note, resting tremor occurs when a person’s hands, arms, or legs shake even when they are at rest; action tremor occurs with the voluntary movement of a muscle.

When the researchers included other factors (age, sex, etc.) in their model, most of these differences were no longer statistically significant. However, tremor scores were still significantly lower among coffee drinkers. More specifically, coffee drinkers had significantly lower scores for tremors at rest (1.49 vs. 2.41), whereas scores for action tremors were not very much  different between the two groups once other variables were taken into account.

Furthermore, this association was dose-dependent. That is, the more coffee participants reported drinking, the lower their tremor scores tended to be.

Researchers then divided the patients by sex and performed a similar analysis. Interestingly, tremor scores were significantly lower among male coffee drinkers as compared to male non-coffee drinkers, but this association was not statistically significant for females. This suggests sex-dependent differences on the effects of coffee in Parkinson’s patients.

The researchers speculated that such differences may be attributable to hormones that are typically present at different levels between the sexes, most notably estrogen. But further research will be needed to determine whether this idea holds water.

“Coffee consumption and tremor severity are inversely related in male patients with de novo [Parkinson’s disease],” the researchers wrote. “Further investigations are needed to reveal the exact causal relationship between coffee consumption and tremor in [Parkinson’s disease] patients,” they added.

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Intimacy Can Be Challenging with Parkinson’s Disease


Sherri Journeying Through

The other day, my husband told me he felt alone. Then he said he felt distanced. How could that be? We are together almost every day, 24/7. But being together and being together are very different, especially when it comes to having Parkinson’s disease.

This disease has many symptoms, of which tremor is the most prominent. Other symptoms are not often discussed, particularly depression. Another that I will discuss in this column is intimacy difficulty. 

Most people with Parkinson’s are aware that intimacy can be an issue for many reasons. One may be an unintentional lack of interest the person with PD may not even be aware of. Another may be pain or discomfort. Yet another may be the inability to “perform.” Any of these reasons can disrupt the relationship, sending messages of rejection or appearing to indicate the partner is undesirable and even unloved. 

First, let me say that, whether you’re the person with PD or the partner, you are not alone. I, too, struggle with this subject for many reasons. I can feel inadequate in many ways, but I didn’t realize I was inadvertently making my husband feel distanced and alone until the other day when we had a heart-to-heart talk.

According to the American Parkinson Disease Foundation, “From lack of sexual desire to low libido to difficulties with orgasmic functioning, this chronic, progressive, neurological disease can impair your sexuality in one way or the other.” The Michael J. Fox Foundation adds that “as many as 70 to 80 percent of those with PD experience sexual dysfunction.”

Dealing with bradykinesia, or slowness of movement, and rigidity can become an issue in a relationship. Symptoms such as tremors and dyskinesia also can contribute to dysfunction and leave one or both partners feeling inadequate.

This also plays out in everyday signs of affection such as hugging, kissing, or holding hands. The person with Parkinson’s can appear aloof to the need for affection and leave a partner feeling more distanced with each day. Before long, both are wondering why the other has stopped finding them attractive and don’t want to be with them sexually anymore. I can’t help but believe that the sad stories I have heard about spouses who have left their partners with Parkinson’s disease are more likely due to a lack of communication than just having the disease.

It’s hard to overcome feelings of inadequacy when they are kept bottled up and aren’t talked about. The first person to talk to about how you’re feeling is your partner or spouse. A frank and honest discussion about the effects of Parkinson’s on intimacy and how to overcome it in everyday life is critical. It might mean an intentional hug in the morning or time set aside only for conversation. (This does not include talking while watching the television.)

Speaking of television, the other day, I was watching a show and at the end, a man proposed to his girlfriend. Of course, she said yes — it was a Hallmark movie, after all. Then the guy said, “I hope the magic never fades.” 

None of us wants the magic to fade, especially if we have Parkinson’s. It’s taken so much already. We need to keep communicating with each other, no matter how hard it may be at times. It’s those times that bind us together more tightly, and the tighter we hold each other, the greater the magic will be. 


Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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The ABCs of Parkinson’s: ‘G’ Is for Girls, Gaits, and Gifts

A continuation of the “ABCs of Parkinson’s” series.
The girls
OK, OK. So I’m reaching for examples of the letter “G” to fit for this section. Girls? Yes, girls, speaking toward the female sex. And there is evidence that between boys and girls — er, men and women — that the men outnumber the women when it comes to Parkinson’s disease.
According to, “Parkinson’s disease (PD) is found more frequently in men than in women, occurring in men 50% more than in women.” Is there a reason, an explanation, for this? According to the same article, researchers haven’t yet discovered the answer to that question but suggest that “the protective effect of estrogen in women” may have a role to play. Researchers also tend to attribute head trauma (such as that found in football players, boxers, etc.), which is higher in men than women, as part of the reason for Parkinson’s.
The gait
While there may be differences between men and women when it comes to having Parkinson’s disease, there are also similarities in the symptoms they share with the disease. This includes issues with gait. Because it is one of the symptoms of Parkinson’s that can be seen, it tends to draw undesired attention. 
There is a freezing of one’s gait, which is basically just that: the inability to walk in a smooth, fluid motion without stopping. The patient “freezes up” and has difficulty moving or stepping forward.
Patients also have what is known as a shuffling gait, noted by the appearance of the patient dragging their feet and appearing to fall forward when they walk. These symptoms (a freezing or shuffling gait) usually develop over time during the disease’s progression.
The gifts
Many people with Parkinson’s disease have made reference to having been given a “gift,” so to speak. They feel that priorities shifted after finding out they had Parkinson’s disease. What once was important was no longer, and what is now important, once never was. Family and friendships became foremost. The ability to see what was truly important in life became clearer. Taking things for granted became obsolete and being thankful took on new life. New friendships have formed through having Parkinson’s or being a caregiver of a person with PD.
Gifts don’t have to be wrapped with bows and wrapping paper. Some of the best gifts can’t be wrapped at all, or they come wrapped in flesh. We may have to struggle with other aspects of Parkinson’s disease, but when it comes down to deciding whether PD can be considered a gift or not, it all depends on the recipient.
Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this

Source: Parkinson's News Today