Differences in Parkinson Disease Presentation and Progression by Sex and Reproductive Health Characteristics

Abstract

Background: Female sex and reproductive health characteristics indicative of higher estrogen exposure are associated with a reduced risk of Parkinson disease (PD). However, it is unclear if those risk factors also act as prognostic factors. Past studies examining PD progression have methodological limitations or have only focused on physician assessed, impairment progression. Objective: To examine differences in physician assessed and patient reported PD presentation and progression by sex and reproductive health characteristics. Methods: Analysis was conducted on PD patients who sought care at the University of Maryland PD and Movement Disorders Center. Bivariate analysis was used to compare patient sociodemographics, clinical characteristics, care patterns, and outcomes by sex and reproductive health characteristics. Multiple models of PD progression were explored; linear mixed-effects models with five year spline intervals were selected to examine patient impairment, disability, and health-related quality of life progression and heterogeneity. Sex and reproductive health characteristic interaction terms were added to the mixed-effects models to examine differences. Results: The final study sample included 914 males, 549 females, and 463 post-menopausal females. Females had less social support, more psychological distress, and worse self-reported (but not physician assessed) disability and health-related quality of life at initial PD visits, compared to males. Progression patterns differed by outcome measure and were heterogeneous. For all outcome measures but one, patients improved in the first year of clinical care at the Center. However, there were minimal differences in PD progression by sex and inconsistent differences by reproductive health characteristics. A mediation analysis demonstrated that managing patient psychological distress had the largest impact on reducing sex differences in self-reported disability and health-related quality of life at initial PD visits. Conclusions: The findings emphasize the difference in patient-reported and physician assessed outcome measures as well as the challenge of prognostic counseling in PD. The improvement seen in the first year of care at the Center highlights the need for specialist referral in PD. Females perceived their disease to be worse than males. To improve this difference, psychological distress interventions and management, particularly targeting females, should be implemented as part of PD clinical care.