Gender differences in patients with Parkinson's disease treated with subthalamic deep brain stimulation

Accolla, Ettore A.; Caputo, E.; Cogiamanian, F.; Tamma, Filippo; Mrakic‐Sposta, Simona; Marceglia, Sara; Egidi, M.; Rampini, Paolo; Locatelli, Marco; Priori, Alberto

doi:10.1002/mds.21520

Cited by 78 publications

(67 citation statements)

References 19 publications

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“…Men were more numerous in our cohort: the male to female ratio was 1.42, a distribution consistent with what is reported in Western societies [1]- [4]. Socioeconomic differences were also observed, in which men were more likely to be white, and tended to be privately insured, when compared to women.…”

Section: Discussionsupporting

confidence: 90%

“…Further study is needed to delineate the individual contributions of these confounders. Univariate and multivariate regression analyses were concordant in showing that motor fluctuations and dyskinesia occurred more frequently in women, suggesting a true biologic difference, which has been demonstrated repeatedly in the literature [1] [13] [14]. Specifically, women have been found to achieve higher plasma concentration of levodopa after oral administration, leading to a greater incidence of motor side effects [13].…”

Section: Discussionmentioning

confidence: 57%

“…In many populations, men are more frequently affected than women, with epidemiologic studies in Western nations reporting age-adjusted male to female ratios between 1.35 and 2 [1]- [4]. A meta-analysis performed by Taylor et al demonstrated that Asian nations, including an Asian sub-population in California, observe more balanced ratios than Western populations [5].…”

Section: Introductionmentioning

confidence: 99%

“…Studies in Dutch and Norwegian populations demonstrate that men are significantly younger at PD onset than women by about 2 years [6] [7]. Several studies found no difference in overall disease severity on the Unified Parkinson's Disease Rating Scale (UPDRS) in men and women at disease onset [7] [8] and in groups with mixed disease progression [1] [9]. Men have been found to have more rigidity [9], while women have more gait instability [9] [10].…”

Section: Introductionmentioning

confidence: 99%

“…Men experience sexual dysfunction [8] [11], fatigue [11], olfactory dysfunction [8] [11], and use caregivers more than women [12]. Dyskinesia has been widely reported to cluster in women [1] [13] [14], and women have been observed to experience dysphagia [15], restless legs [11], pain [11], and depressive symptoms more frequently than men [8] [11] [16].…”

Section: Introductionmentioning

confidence: 99%

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Exploring Gender-Associated Socioeconomic Differences in Parkinson’s Disease

McInnis¹,

Cavanaugh²,

Weinberg³

et al. 2015

APD

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Background: Research on gender in Parkinson's disease (PD) frequently focuses on clinical differences between men and women. Socioeconomic factors such as race, ethnicity, insurance type, and level of educational attainment, have not been extensively examined in relation to gender differences in PD. The goal of this study was to identify differences in PD presentation in men and women, and identify socioeconomic factors that may confound such differences. Methods: A movement disorder patient database containing 445 patients with idiopathic PD was analyzed for gender differences in motor symptoms and disease complications using linear or logistic regression. Socioeconomic variables were then evaluated as possible confounders. Results: A greater proportion of women were non-white (p < 0.05). Univariate analysis of gender, and multivariate analysis controlling for age at diagnosis and socioeconomic factors were concordant in demonstrating increased frequency of motor fluctuations and dyskinesia in women (p < 0.05). Controlled, multivariate analysis, when compared to univariate analysis, uniquely demonstrated that women were less likely to experience dementia and autonomic dysfunction, relative to men (p < 0.05). Conclusion: Women with PD are susceptible to motor fluctuations and dyskinesia, but may be relatively protected against dementia and autonomic dysfunction. Women and men with PD in our population had different socioeconomic profiles, which may have confounded some gender-associated differences.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Exploring Gender-Associated Socioeconomic Differences in Parkinson’s Disease

McInnis¹,

Cavanaugh²,

Weinberg³

et al. 2015

APD

View full text Add to dashboard Cite

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Neurostimulation for Advanced Parkinson Disease and Quality of Life at 5 Years

Jost,

Aloui,

Evans

et al. 2024

JAMA Netw Open

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ImportanceDeep brain stimulation of the subthalamic nucleus (STN-DBS) improves quality of life (QOL) in patients with advanced Parkinson disease (PD). However, controlled studies with more than 3 years of follow-up are lacking.ObjectiveTo investigate the long-term effects of STN-DBS on QOL compared with standard-of-care medication (MED).Design, Setting, and ParticipantsIn this prospective, observational, quasi-experimental, longitudinal nonrandomized controlled trial, 183 patients were screened for eligibility and 167 were enrolled from March 1, 2011, to May 31, 2017, at 3 European university centers. Propensity score matching for demographic and clinical characteristics was applied to 108 patients with PD (62 in the STN-DBS group and 46 in the MED group), resulting in a well-balanced, matched subcohort of 25 patients per group. Data analysis was performed from September 2022 to January 2023.ExposureTreatment for PD of STN-DBS or MED.Main Outcomes and MeasuresAssessments included Parkinson’s Disease Questionnaire 8 (PDQ-8), Unified PD Rating Scale–motor examination, Scales for Outcomes in PD–activities of daily living (ADL) and motor complications, and levodopa-equivalent daily dose. Within-group longitudinal outcome changes, between-group differences, and correlations of change scores were analyzed.ResultsThe study population in the analysis included 108 patients (mean [SD] age, 63.7 [8.3] years; 66 [61.1%] male). At 5-year follow-up, PDQ-8 and ADL worsened only in the MED group (PDQ-8 change, −10.9; 95% CI, −19.0 to −2.7; P = .01; ADL change: −2.0; 95% CI, −3.1 to −0.8; P = .002), whereas both outcomes remained stable in the STN-DBS group (PDQ-8 change, −4.3; 95% CI, −13.2 to 4.7; P = .34; ADL change, −0.8; 95% CI, −2.5 to 1.0; P = .38). Changes in PDQ-8 and ADL correlated moderately (rs = .40, P = .008). Furthermore, STN-DBS outcomes were favorable for motor complications (median difference in change scores between STN-DBS and MED, −2.0; 95% CI, −4.0 to −1.0; P = .003), mobility (−1.0; 95% CI, −2.0 to 0; P = .03), and levodopa-equivalent daily dose reduction (−821.4; 95% CI, −1111.9 to −530.8; P &lt; .001).Conclusions and RelevanceThis study provides evidence of differences in QOL outcomes at 5-year follow-up between STN-DBS (stable) and MED (worsened), mainly driven by the favorable effect of STN-DBS on mobility (class IIb evidence). The association between changes in QOL and ADL, but not motor impairment or complications, highlights the relative importance of ADL outcomes for long-term DBS assessments.Trial RegistrationGerman ClinicalTrials Registry: DRKS00006735

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Prevalence and Correlates of Anti‐Parkinson Drug Use in a Nationally Representative Sample

Dahodwala

Willis

et al. 2016

Movement Disord Clin Pract

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Background Although numerous prescription drugs are available to treat Parkinson's disease (PD), little is known about national use in clinical practice and which factors may influence variability in care. The objectives of this study were to describe the prevalence of anti‐Parkinson drug use among Medicare beneficiaries with PD and to identify demographic and clinical factors associated with drug use. Methods This retrospective study was based on a random sample of annual 5% Medicare Part A and B claims linked with Medicare Part D drug files from 2007 through 2010. The study sample included fee‐for‐service Medicare beneficiaries with continuous stand‐alone Part D enrollment who had been diagnosed with PD in the given year. First, any PD drug use and drug use by class (levodopa, dopamine agonist, anticholinerigc, monoamine oxidase B inhibitors, catechol‐O‐methyltransferase inhibitors, and amantadine) were described. Using generalized estimating equation regressions, patient and provider characteristics associated with anti‐Parkinson drug use and choice were examined. Results Over 81% of patients with PD were treated with anti‐Parkinson drugs, and this proportion was stable over the 4 years of the study. The majority were treated with levodopa (90%); followed by dopamine agonists (29–31%); then monoamine oxidase B inhibitors, anticholinergics, amantadine, and catechol‐O‐methyltransferase inhibitors (all between 5% and 11%). Holding all else equal, patients who were not seen by a neurologist (odds ratio, 0.41; 95% confidence interval, 0.38–0.44; P < 0.001) and African‐American patients (odds ratio, 0.80; 95% confidence interval, 0.69–0.93; P = 0.003) were significantly less likely to be treated. Conclusions Among a national sample of Medicare beneficiaries with PD, the majority received anti‐Parkinson drugs. However, there was relative under‐treatment of African‐Americans and patients who were not seen by a neurologist for care.

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Gender differences in patients with Parkinson's disease treated with subthalamic deep brain stimulation

Cited by 78 publications

References 19 publications

Exploring Gender-Associated Socioeconomic Differences in Parkinson’s Disease

Exploring Gender-Associated Socioeconomic Differences in Parkinson’s Disease

Neurostimulation for Advanced Parkinson Disease and Quality of Life at 5 Years

Prevalence and Correlates of Anti‐Parkinson Drug Use in a Nationally Representative Sample

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