Gender differences in Parkinson disease

Abstract

The incidence of Parkinson disease (PD) is twice as high in men as in women in the West. The cause of the gender difference has been suggested to be the protective effect of estrogen on neurodegeneration, but this has not been clarified. In Japan, the incidence of PD is higher in women. Gender differences in clinical symptoms of PD have also been reported. Women have a later age of onset of motor symptoms, but are more prone to postural instability, are at higher risk for falls and progression to frailty, and are at higher risk for levodopa–associated motor complications. There are also gender differences in the pharmacokinetics of L–dopa preparations, the gold standard for PD treatment. In general, the bioavailability of levodopa is higher in women, and the area under the curve (AUC) of L–dopa is known to be 17∼27% higher in women than in men. This is speculated to be a contributing factor to dyskinesia induction. Furthermore, it has been noted that female patients with PD have disparities in treatment choice and care, including inadequate opportunities to choose device–aided therapies such as deep brain stimulation, and fewer opportunities to receive nursing care. Although information on gender differences is limited, we would like to provide appropriate treatment for each patient.