Gender differences in motor and non-motor symptoms among Sardinian patients with Parkinson's disease

Background: Parkinson's disease (PD) occurs more frequently in men than in women and a higher risk for PD development in males compared with females has been hypothesized, suggesting gender may be a significant factor in the development and progression of parkinsonism. To date, gender differences in non-motor symptoms are under-reported. Objective: To assess gender differences in motor and non-motor symptoms among Sardinian PD patients. Methods: One hundred fifty-six (91 male and 65 female) consecutive Sardinian PD outpatients were included in this analysis. Modified Hoehn and Yahr scale and UPDRS were used to assess motor symptoms, while non-motor disturbances were evaluated with the non-motor symptoms scale (NMSS). Presence of depression, anxiety and other iatrogenic behavioral disorders was also investigated. In order to determine how gender differences could be specific to PD, 132 age-matched normal controls were assessed with the NMSS. Results: Women were more likely than men to present with tremor as initial symptom (p <.025) and worse UPDRS instability score (p <.02). NMSS score in females was significantly higher than that in males (p <.018). A significantly higher severity in cardiovascular (p < 0.002), sleep/fatigue (p <.018) and mood/apathy (p <.001) domains was observed in female PD patients, while the sexual dysfunction domain was reported with a significantly higher score in male patients (p <.017). Fatigue (p <.03), lack of motivation (p <.015) and sadness (p <.009) were observed significantly more frequent in females, while altered interest in sex was noted as more common in males (p <.001). Frequency of depression (p <.011) and anxiety (p <.001) was significantly higher in females, while male patients had increased frequency of compulsive sexual behaviors (p <.05). There was a significantly higher frequency of non-motor symptoms in eight domains in both male and female PD patients compared with controls (p <.001, for all comparisons, with the exception of urinary disturbances in females: p <.004). Only sexual dysfunctions were not significantly higher in male and female PD patients compared with controls. Discussion: The present study highlights the role of gender differences associated with the occurrence of motor and non-motor disorders and our findings indicate that spectrum and severity of non-motor symptoms may present with different gender distribution in PD patients, suggesting a possible sex-related effect. © 2012 Elsevier B.V. All rights reserved.