Sex or gender disparities clear in Parkinson’s, need attention: Report
Specific focus placed on females with this disease by international team
Parkinson’s disease research and care should address disparities by sex and gender in patients’ symptoms, treatment responses, and disease progression, scientists across Europe and North America state in a commentary.
While sex refers to assigned biological differences between males and females, gender refers to how a person identifies, affecting their physical and economic well-being.
The scientists, whose particular focus was female patients, proposed strategies for better informed approaches to Parkinson’s, such as training healthcare professionals and educating patients and those helping them about disease-related sex differences. These include harsher disease symptoms being more likely in men, while women appear to have faster progression.
Researchers also favored including more women in clinical trials, and promoting workplace policies better supporting women with the disease, noting that these patients are “less likely to be employed.”
‘Significant disparities’ seen in disease diagnosis, progression, and symptoms
“As we uncover the significant disparities … between men and women with Parkinson’s, it becomes essential to address these critical differences,” Josefa Domingos, president of Parkinson’s Europe and a report co-author in Portugal, said in a news release by the organization. “With this initiative, we aim to raise collective awareness and … help pave the way toward a future where personalized care is not just an aspiration but a reality — ensuring a better quality of life for everyone living with Parkinson’s.”
“This work, supported by Abbvie, highlights the unique perspective of women living with Parkinson’s disease,” added Antonella Santuccione-Chadha, MD, president of the Women’s Brain Foundation, based in Switzerland, and a report co-author.
The commentary, “Using a Sex- and Gender-Informed Lens to Enhance Care in Parkinson’s Disease,” was authored by a group of 10 Parkinson’s specialists across Europe and North America, and published in Nature Medicine.
Parkinson’s is caused by the progressive loss of dopaminergic neurons, the nerve cells responsible for making a chemical messenger called dopamine, ultimately giving rise to disease symptoms.
Although the disease is typically considered to be more common in men, recent studies have shown closer prevalence rates between the sexes and higher rates in women in some instances.
“It is increasingly clear that there are sex and gender differences in [Parkinson’s], including in symptoms, disease progression, treatment response, quality of life and needs in care,” the scientists wrote.
These differences include more severe Parkinson’s motor symptoms, such as slowness of movement and rigidity, and nonmotor disease symptoms such as poorer cognitive abilities in men. Women — typically with a later motor symptom onset — tend to have tremor-dominant disease, be more prone to dyskinesia (sudden, uncontrolled movements), and more likely to experience depression, anxiety, pain, and fatigue.
Women also are seen to have faster disease progression then men, and to be at an “80.1% greater risk” of off episodes, periods when the effectiveness of levodopa, a mainstay Parkinson’s treatment, wears off and symptoms return before a next dose can be taken.
This finding “suggests an urgent need to develop treatment approaches that take sex into account,” the scientists wrote.
Hormonal changes across a women lifetime, such as those during periods, pregnancy, and menopause, may affect a woman’s risk of developing Parkinson’s. The scientists noted that early-onset Parkinson’s (before the age of 50) is seen to be more likely in women with an early age at menopause.
Black women in US have longest delays in diagnosis, access to care
The commentary also discussed how the perception of Parkinson’s as mostly affecting older white men often delays a disease diagnosis and referrals to movement disorder specialists for women.
“Training on sex and gender differences … would ensure that healthcare professionals can provide personalized care after diagnosis, while awareness campaigns that challenge gender stereotypes and stigma related to [Parkinson’s] would help with public understanding,” the researchers wrote.
Women of color are particularly affected, with Black female patients in the U.S. showing the longest delays in diagnosis and access to care, followed by Black men, the team noted.
Suggestions made to improve the care of women with Parkinson’s include the use of gender-neutral language (e.g., “journey partner” instead of caregiver), promoting early diagnosis and gender-inclusive care practices, and raising awareness among journey partners and the public on Parkinson’s sex-related differences.
Other recommendations include strategies addressing sex differences in disease risk factors, such as exposure to neurotoxic substances like farm pesticides and industrial chemicals. The team noted that women from minority groups in low- and middle-income countries “face the greatest exposure” to such substances.
“This paper underscores the urgent need to strengthen research on sex/gender for understanding disparities in [Parkinson’s] and to provide inclusive and tailored care frameworks,” said Roberta Marongiu, PhD, Women’s Brain Foundation board member and a professor of neuroscience at Weill Cornell Medicine in New York. “Addressing these disparities will improve outcomes and quality of life for all patients, particularly women and underserved groups.”
About the Author
