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Gender differences in Parkinson’s disease

¹ Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
² Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
³ Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
⁴ Department of Neurology, Groningen University Medical Centre, Groningen, the Netherlands
⁵ Department of Nuclear Medicine, Academic Medical Centre, Amsterdam, the Netherlands
⁶ Department of Anatomy, Northeastern Ohio Universities, College of Medicine, Rootstown, Ohio, USA

Correspondence to:
Correspondence to:
Dr Bastiaan R Bloem
Department of Neurology (935), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; b.bloem{at}neuro.umcn.nl

Objective: To investigate gender differences in basic disease characteristics, motor deterioration and nigrostriatal degeneration in Parkinson’s disease (PD).

Methods: We studied 253 consecutive PD patients who were not receiving levodopa or dopamine agonists (disease duration 10 years). We investigated the influence of gender and oestrogen status on: (1) age at onset, (2) presenting symptom, (3) severity and progression of motor symptoms (Unified Parkinson’s Disease Rating Scale III (UPDRS-III) scores) and (4) amount and progression of nigrostriatal degeneration ([¹²³I]FP-CIT single photon emission computed tomography measurements).

Results: Age at onset was 2.1 years later in women (53.4 years) than in men (51.3 years). In women, age at onset correlated positively with parity, age at menopause and fertile life span. Women more often presented with tremor (67%) than men (48%). Overall, patients presenting with tremor had a 3.6 year higher age at onset and a 38% slower UPDRS-III deterioration. Mean UPDRS-III scores at disease onset were equal for both genders, as was the rate of deterioration. Women had a 16% higher striatal [¹²³I]FP-CIT binding than men at symptom onset and throughout the course of PD.

Conclusions: Our results suggest that, in women, the development of symptomatic PD may be delayed by higher physiological striatal dopamine levels, possibly due to the activity of oestrogens. This could explain the epidemiological observations of a lower incidence and higher age at onset in women. Women also presented more often with tremor which, in turn, is associated with milder motor deterioration and striatal degeneration. Taken together, these findings suggest a more benign phenotype in women with PD.

Abbreviations: PD, Parkinson’s disease; SPECT, single photon emission computed tomography; sUPDRS-III, selection of items of the Unified Parkinson’s Disease Rating Scale III; UPDRS-III, Unified Parkinson’s Disease Rating Scale III

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