Potential sex differences in nonmotor symptoms in early drug-naive Parkinson disease

Abstract

Objective: To examine potential sex differences in nonmotor symptoms (NMS) among drug-naive patients with Parkinson disease (PD), and to identify NMS that can best differentiate patients with early PD from controls. Methods:Our cross-sectional analysis included 414 newly diagnosed, untreated patients with PD (269 men and 145 women) and 188 healthy controls (121 men and 67 women) in the Parkinson's Progression Markers Initiative Study. NMS were measured using well-validated instruments covering sleep, olfactory, neurobehavioral, autonomic, and neuropsychological domains.Results: Male and female patients with PD were fairly comparable on motor presentations but differed on several nonmotor features. Male patients with PD had significantly more pronounced deficits in olfaction (p 5 0.02) and in certain cognitive measurements (all p , 0.01) than female patients, whereas female cases experienced higher trait anxiety (p 5 0.02). Multiple stepwise logistic regression analysis showed that the combination of NMS measures-University of Penn- Conclusions: Our analysis revealed notable sex differences in several nonmotor features of patients with de novo PD. Furthermore, we found a parsimonious NMS combination that could effectively differentiate de novo cases from healthy controls. Nonmotor symptoms (NMS) are common among patients with Parkinson disease (PD) 1 and contribute greatly to poor quality of life, morbidity, and mortality.2,3 Despite their significant impacts, NMS among patients with PD remain poorly understood and, consequently, undertreated.2 Furthermore, some NMS, such as hyposmia, depression, REM sleep behavior disorder (RBD), and constipation, may even precede PD clinical diagnosis by years.Clinical and epidemiologic studies have increasingly recognized and investigated the importance of NMS in understanding the natural history, etiology, and clinical care of PD.3,4 However, most previous studies of NMS used hospital-based prevalent PD cases, had small sample sizes, and often lacked a comparable control group. Although a few studies did assess NMS among patients with untreated, de novo PD, 5-8 most did not have sufficient sample size to evaluate potential sex differences [5][6][7] or focused executively on one or a limited number of specific

Structural Brain Sex Differences in Parkinson’s Disease: A Voxel-Based Morphometry Study

“…Moreover, autonomic dysfunction was found to be significantly higher in PD patients than in HC. This result was consistent with previous studies [57,67]. In comparing PD males and females, no significant results were found.…”

“…Additionally, this result was consistent with a previous study that had studied olfaction in neurodegenerative diseases, including idiopathic PD [57,66]. When comparing males and females with PD, significant loss of smelling sense was found more in males than females; this result was consistent with a recent large sample of non-motor symptoms [67]. Moreover, males with PD showed significant loss of GM in the frontal area of the brain compared to females with PD, such as the right frontal medial cortex, the right subcallosal cortex, the bilateral frontal orbital cortex, and in associated areas of the limbic system and temporal lobe, which might aid in the development of this issue [68].…”

“…Furthermore, loss of cognition function affected males more than females, and this was based on the high level of significance compared to females. The results were consistent with previous literature that had investigated sex differences in PD, suggesting that daily life activities might become affected by the cognitive decline in males more than females [46,65,67]. Moreover, autonomic dysfunction was found to be significantly higher in PD patients than in HC.…”

“…In comparing PD males and females, no significant results were found. Interestingly, males in the HC subgroup had more autonomic dysfunction than females, and a difference among the HC group was found, coinciding with a previous study [67].…”

Sleep-wake disturbances in the premotor and early stage of Parkinson's disease

“…Combining several of these markers, subpopulations can be identified with up to 65% conversion rates risk in 3 years [26 && ]. Interestingly, the presence of RBD symptoms in combination with hyposmia and cognitive decline in women could effectively differentiate de-novo Parkinson's disease cases from healthy controls [43] ], early biochemical changes, such as the downregulation of serum for specific miRNAs (miR-19b) [45] and specific genetic polymorphisms [46] have been also suggested as promising markers to predict phenoconversion of iRBD into a synucleinopathy.…”