Sex differences in Parkinson's disease presentation and progression

• Published in: Parkinsonism & related disorders 2019-12, Vol.69, p.48-54
• Main Authors: Abraham, Danielle S., Gruber-Baldini, Ann L., Magder, Laurence S., McArdle, Patrick F., Tom, Sarah E., Barr, Erik, Schrader, Katrina, Shulman, Lisa M.
• Format: Article
• Language: English
• Subjects: Activities of daily living; Aged; Cohort Studies; Disease Progression; Female; Humans; Male; Middle Aged; Parkinson Disease - complications; Parkinson Disease - physiopathology; Parkinson Disease - psychology; Parkinson's disease; Patient Reported Outcome Measures; Quality of life; Quality of Life - psychology; Sex Characteristics; Sex differences
• ISSN: 1353-8020; 1873-5126; 1873-5126
• DOI: 10.1016/j.parkreldis.2019.10.019

Females have a reduced risk of Parkinson's disease (PD). However, it is unclear if sex is a prognostic factor. We aimed to examine differences in presentation, physician- and patient-reported PD outcomes, and progression by sex in a large clinical cohort. This study was a secondary analysis of a cohort of PD patients seen at a tertiary care center. Sociodemographic and clinical characteristics, treatment, care timing, and outcomes were examined by sex. Sex differences in progression of impairment, disability, and health-related quality of life (HRQoL) were tested with five-year piecewise linear mixed-effects models. A mediation analysis assessed drivers of sex differences. The study included 914 males and 549 females. Females had significantly less social support, more psychological distress, and worse self-reported (but not physician-reported) disability and HRQoL at initial PD care visits, compared to males. Addressing anxiety symptoms may attenuate this difference. PD progression sex differences were minimal. PD progression does not differ by sex, yet patient-reported measures of disease severity are worse in females than males. To attenuate this sex difference in disease experience, psychological distress screening and management, particularly targeting females, should be implemented as part of PD clinical care. •Females with PD have less social support and report worse psychological distress.•Sex minimally influences PD progression.•Females report worse disability and HRQoL at initial visits for PD specialty care.•Improved anxiety management can attenuate sex differences in disability and HRQoL.•Patient reported outcome measures are vital to understanding patients' experiences.