Gender differences in Parkinson's disease: A clinical perspective

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Parkinson's disease (PD) is a chronic neurodegenerative disease. Its main pathological feature is degeneration of substantia nigra pars compacta (SNc) leading to reduced dopamine production.1 This, together with degeneration of other brain regions, subsequently leads to resting tremor, rigidity, bradyhypokinesia, and postural instability, which are the main motor manifestations of the disease.2 In addition, there is an abundance of non‐motor symptoms (NMS), such as hyposmia, constipation, REM sleep behavior disorder (RBD), pain, depression, and cognitive disturbances that also contribute to disability in activities of daily living (ADL) and decreased quality of life (QoL).3
Available data indicate that there are gender differences in many features of PD. Not only epidemiological characteristics of the disease differ between men and women with PD, but there are also differences in clinical presentation of both the motor and non‐motor features of the disease.4 Taking these differences in consideration might help diagnosis, tailor treatment, predict outcomes, and meet social and other needs in men and women with PD.5 Despite PD being the most frequently studied movement disorder, studies investigating gender differences in PD are still scarce. In addition, it is not clear how clinically relevant the already described gender differences in PD are in order to be used to differentially diagnose and treat PD. In this study, we will use the term gender in its broader sense—encompassing both the biological (ie, sex) differences and the social, cultural, and personal implications of what it means to be a woman or a man (ie, gender), keeping in mind that both terms—sex and gender—have often been used interchangeably in the medical literature.6
The main aim of this study was to review the clinical studies systematically exploring gender differences in PD. Because of paucity of data, gender differences in other parkinsonisms are not reviewed here (Table 1).7 We will first look at the gender differences in epidemiology (incidence, prevalence, age at onset) and then move to gender differences in both motor and non‐motor clinical presentations (cognition, depression, anxiety, apathy, fatigue, pain, autonomic dysfunction, hyposmia, sleep) as well as explore differences in ADL/QoL measures and in treatment of PD.
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