Is Parkinson's in Women Different Than in Men?

Biological sex differences go beyond internal and external anatomical differences. These differences can greatly impact the etiology and pathophysiology of many diseases and, consequently, can influence incidence, diagnostic accuracy, and clinical outcomes. 

Among neurological conditions that may be influenced by biological sex is Parkinson’s disease. While the risk of developing Parkinson’s disease is 1.5 as high in men than in women, research shows that women have a higher mortality rate and faster progression of the disease. In the U.S. alone, there are more than 400,000 women living with Parkinson’s disease—yet, women with Parkinson’s disease remain severely underrepresented in Parkinson’s research.

There is still a clear and urgent need for more research in this space, however, we are starting to see some research bringing these differences to light. In this article, we will take a look at emerging research surrounding Parkinson’s in women versus men and the role of research in delivering personalized treatment and care.

Parkinson’s in Women Versus Men

Current evidence points to biological sex as an important factor involved in the development and expression of Parkinson’s disease. It is possible that Parkinson’s disease development involves distinct pathological mechanisms in male and female patients. Alternatively, it may involve the same mechanism but act differently between biological sexes. Regardless, emerging research shows that there may be a physiological difference in how Parkinson’s disease pathology manifests in women versus men. While research is still highly limited, studies suggest the following differences.

Prevalence, Onset & Progression:

• Men are more likely than women to develop Parkinson’s disease. Some believe estrogen has a neuroprotective effect in women. Some believe men are more likely to experience head trauma and be exposed to toxins which are both established risk factors for Parkinson’s disease development. Others suggest an X linkage of genetic risk factors.
• Age of Parkinson’s disease onset may be later in women compared to men.
• Compared to men, women have a higher mortality rate and experience a faster rate of progression.

Motor and Non-Motor Symptoms:

• Women may experience different motor and non-motor symptoms at different severities. Motor symptoms have been found to emerge later in women with different characteristics, such as reduced rigidity, a higher tendency to develop postural instability, and tremor as a more common initial symptom. Research shows that non-motor symptoms—such as depression, fatigue, restless legs, pain, constipation, loss of taste or smell, excessive sweating, and weight change—are more common and more severe in women.
• Women report worsening symptoms during perimenopause. Some researchers hypothesize this to be related to the decreased levels of estrogen.
• Women are at an elevated risk for levodopa-related motor complications. Minor changes in medications or the timing of medications can increase the negative side effects, such as dyskinesia, in women.
• Research suggests that men with Parkinson’s disease have worse general cognitive abilities. One study found that women with Parkinson’s disease perform better at the Symbol Digit Modalities Test, verbal fluency tests, and overall cognitive function, as measured by the Montreal Cognitive Assessment (MoCA). However, it has also been found that women have worse visuospatial abilities.

Psychosocial Aspects:

• Women with Parkinson’s disease have less social support and report worse psychological stress.
• Women with Parkinson’s disease are more likely to live alone and attend medical appointments alone.
• Women with Parkinson’s disease are at greater risk of receiving lower-quality care.

Identifying and understanding the differences in Parkinson’s in women versus men will likely play a crucial role in terms of diagnostic accuracy and therapeutic approaches. Continued research and increased awareness around these differences may help bridge the gap in patient care by better capturing the needs of women with Parkinson’s disease.

The Path Towards Precision Care

Ultimately, clinical research drives patient care. To be able to provide precise, personalized treatment and care, we need to understand the role of aspects such as biological sex, genetics, and cultural context in Parkinson’s disease. With a greater understanding of how hormones and biological sex influence Parkinson’s disease, healthcare providers can customize management plans to adjust for unique stages of women’s lives, including during menstruation, pregnancy, perimenopause, menopause, and postmenopause. 

More research surrounding the differences between men and women with Parkinson’s disease is fundamental to the ability to provide women with equal care and treatment. There is still much to be learned about the effect of biological sex on Parkinson’s disease development, progression, and response to treatments and therapies.