Symptoms of Parkinson’s: Men vs. Women
Parkinson’s Disease and Gender
More men than women are diagnosed with Parkinson’s disease (PD), by almost a two to one margin. Several studies support this often quoted number, including a large study in the American Journal of Epidemiology.
Usually there is a physiological reason for a difference in disease between men and women. How does being female protect against Parkinson’s disease? Do women and men experience Parkinson’s symptoms differently?
Women develop Parkinson’s less often, and when they do, the age of onset is two years later than in men, according to the Internal Review of Psychiatry.
When women are first diagnosed, tremor is usually the dominant symptom. The initial symptom in men is usually slow or rigid movement (bradykinesia).
The tremor-dominant form of PD is associated with a slower disease progression and higher quality of life. However, women often report less satisfaction with their quality of life, even with a similar level of symptoms.
Female PD patients may encounter more problems during treatment of their PD symptoms than men.
Women receive surgery less often than men do, and their symptoms are more severe by the time they get surgery. Also, the improvements gained from surgery may not be as great.
Drugs to treat Parkinson’s symptoms may also affect women differently. Due to a lower body weight, women often are exposed to higher doses of medications. This has been a problem with levodopa, one of the most common medications for PD. This higher exposure can lead to an increased rate of negative side effects like dyskinesias.
Coping with PD
Men and women often have different responses to the experience of living with Parkinson’s disease.
Women with PD tend to experience a higher rate of depression than men with PD do. They therefore receive antidepressant medication more often.
Men may have more behavioral problems and aggression, such as a greater risk of wandering and inappropriate or abusive behavior. Men are more likely to receive antipsychotic medications to treat this behavior.
PD can affect mental faculties and the senses as well as muscle control. There is some evidence that men and women are affected differently. For instance, men appear to retain a better ability to understand spatial orientation. Women, on the other hand, retain more verbal fluency.
These types of skills are influenced not only by gender, but also by the “side” of PD symptoms. Left side or right side motor symptom onset reflects which side of the brain has the most dopamine deficits. Different skills, such as spatial abilities, are more dominant on a specific side of the brain.
PD rigidity can cause the muscles of the face to “freeze.” This leads to a mask-like, severe expression. As a result, patients with PD have difficulty expressing emotion with their faces. They also can begin to have difficulty interpreting others’ facial expressions.
Both men and women with PD can have difficulty interpreting anger and surprise. Men are more likely to lose the ability to interpret fear.
However, women may be more upset by their inability to interpret emotions. All PD patients may benefit from speech and physical therapy to help with this symptom.
Rapid eye movement behavior disorder (RBD) is a sleep disorder that occurs during the REM sleep cycle. Normally, a sleeping person has no muscle tone and doesn’t move during sleep. In RBD, a person can move limbs and seem to act out their dreams.
RBD occurs rarely, but more often in patients with neurodegenerative diseases. About 15 percent of Parkinson’s patients have RBD, according to the Internal Review of Psychiatry. Men are much more likely to have this condition than women.
Why are there differences in PD symptoms between men and women? It seems likely that estrogen exposure protects women from some PD progression. A study published in the Journal of Neurology, Neurosurgery & Psychiatry found that a woman who experiences later menopause or has more children is more likely to have delayed onset of PD symptoms. These are both markers of estrogen exposure over her lifetime.
What is not yet fully explained is why estrogen has this effect. A study in the American Journal of Psychiatry has shown that women have more available dopamine in key areas of the brain. Estrogen may serve as a neuroprotectant for dopamine activity.
- Haaxma, C. et al. (2007, August). Gender Differences in Parkinson’s Disease. J. Neurol. Neurosurg. Psychiatry, 78(8), 819-824. Retrieved August 14, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117736/
- Miller, I. & Cronin-Golomb, A. (2010, December). Gender Differences in Parkinson’s Disease: Clinical Characteristics and Cognition. Mov. Disord., 25(16), 2695-2703. Retrieved August 14, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003756/
- Mozley, L. et al. (2001, September). Striatal Dopamine Transporters and Cognitive Functioning in Healthy Men and Women. Am. J Psychiatry, 158, 1492-1499. Retrieved August 15, 2013, from http://ajp.psychiatryonline.org/article.aspx?articleid=175022
- Paparrigopoulos, T. (2005). REM sleep behavior disorder: Clinical profiles and pathophysiology. Int. Rev. Psychiatry, 17(4), 293-300. Retrieved August 15, 2013, from http://informahealthcare.com/doi/abs/10.1080/09540260500104540
- Pavon, J. et al. (2010, April). Parkinson’s disease in women: A call for improved clinical studies and for comparative effectiveness research. Maturitas, 65(4), 352-358. Retrieved August 15, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875870/
- Post, B. et al. (2007, October). Prognostic factors for the progression of Parkinson’s disease: A systematic review. Mov. Disord., 22(13), 1839-1851. Retrieved August 15, 2013, from http://onlinelibrary.wiley.com/doi/10.1002/mds.21537/abstract;jsessionid=0F5B32A734A35936FE9133F7412731EA.d04t02
- Schrag, A. et al. (2000). What contributes to quality of life in patients’ with Parkinson’s disease? J Neurol. Neurosurg. Psychiatry, 69, 308-312. Retrieved August 15, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737100/pdf/v069p00308.pdf
- Van Den Eeden, S. et al. (2003). Incidence of Parkinson’s Disease: Variation by Age, Gender and Race/Ethnicity. Am. J. Epidemiol,, 157(11), 1015-1022. Retrieved August 14, 2013, from http://aje.oxfordjournals.org/content/157/11/1015.full