Sex Differences in Parkinson’s Disease: From Bench to Bedside

Abstract

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease and gender differences have been described on several aspects of PD. In the present commentary, we aimed to collect and discuss the currently available evidence on gender differences in PD regarding biomarkers, genetic factors, motor and non-motor symptoms, therapeutic management (including pharmacological and surgical treatment) as well as preclinical studies. Methods: A systematic literature review was performed by searching the Pubmed and Scopus databases with the search strings “biomarkers’’, ‘‘deep brain stimulation’’, “female”, ‘‘gender’’, ‘‘genetic”, ‘‘levodopa’’, ‘‘men’’, “male”, ‘‘motor symptoms’’, ‘‘non-motor symptoms’’, ‘‘Parkinson disease’’, ‘‘sex’’, ‘‘surgery’’, and ‘‘women’’. Results: The present review confirms the existence of differences between men and women in Parkinson Disease, pointing out new information regarding evidence from animal models, genetic factors, biomarkers, clinical features and pharmacological and surgical treatment. Conclusions: The overall goal is to acquire new informations about sex and gender differences in Parkinson Disease, in order to develop tailored intervetions.

Sex Differences in Motor and Non-Motor Symptoms among Spanish Patients with Parkinson’s Disease

“…Multiple studies analyzing sex differences in PD have been published to date. Many of them have been case-control, retrospective, or cross-sectional studies, and lack consistent findings [ 2 ]. In our cross-sectional analysis, we detected many differences between males and females but not in age and time from symptoms onset, so both groups were appropriate to compare.…”

“…Additionally, in our cohort, primary education, to receive more drugs for other diseases, and assistance to a PD association tended to be more frequent in women, as opposed to harmful habits (smoking and alcohol consumption), which were significantly more frequent in males. Although lifestyle factors are important in PD [ 34 ], reviews about the differences in PD by sex lack information about these factors and focus more other aspects [ 1 , 2 , 11 , 35 , 36 , 37 , 38 , 39 ].…”

“…Previously published data indicated that there are sex differences in many features of Parkinson’s disease (PD) [ 1 , 2 ]. Incidence and prevalence of PD are between 1.5 and 2 times higher in men than in woman and disease onset in women is slightly later than in men [ 3 , 4 ].…”

“…Regarding non-motor symptoms (NMSs), some studies have observed that symptoms such as fatigue, depression, anxiety, and sleep problems are more frequent in females, whereas other NMSs such as drooling, diurnal somnolence, urinary and sexual dysfunction, and cognitive problems are more prevalent in males [ 8 , 9 , 10 ]. However, the results are not consistent due to the great heterogeneity between the studies [ 2 ], including aspects such as the sample (e.g., differences in age, disease duration, or race), the type of evaluation conducted, or the follow-up period. Although several findings indicate that estrogens may play a role in PD and explain some sex differences, other mechanisms such as gene expression, neuroinflammation, oxidative stress, and lifestyle factors could be involved [ 11 , 12 ].…”

Association between Parkinson’s Disease Medication and the Risk of Lower Urinary Tract Infection (LUTI): A Retrospective Cohort Study

“…Interestingly, these sex-related differences were also shown in a multicentric study on levodopa-naive PD patients receiving levodopa/benserazide for the first time. The authors of this study found that female sex and body mass index significantly predicted area under the curve (AUC) and maximum concentration (C max ) [ 37 , 38 ]. Based on these data, it is conceivable that sex differences may result in different clinical responses to PD treatment and thereby influence clinical features of PD, accounting for increased LUTI risk in a different way.…”