What Tests Will Be Done To Diagnose This Condition
When healthcare providers suspect Parkinsons disease or need to rule out other conditions, various imaging and diagnostic tests are possible. These include:
- Blood tests .
- Positron emission tomography scan.
New lab tests are possible
Researchers have found possible ways to test for possible indicators or Parkinsons disease. Both of these new tests involve the alpha-synuclein protein but test for it in new, unusual ways. While these tests cant tell you what conditions you have because of misfolded alpha-synuclein proteins, that information can still help your provider make a diagnosis.
The two tests use the following methods.
- Spinal tap. One of these tests looks for misfolded alpha-synuclein proteins in cerebrospinal fluid, which is the fluid that surrounds your brain and spinal cord. This test involves a spinal tap , where a healthcare provider inserts a needle into your spinal canal to collect some cerebrospinal fluid for testing.
- Skin biopsy. Another possible test involves a biopsy of surface nerve tissue. A biopsy includes collecting a small sample of your skin, including the nerves in the skin. The samples come from a spot on your back and two spots on your leg. Analyzing the samples can help determine if your alpha-synuclein has a certain kind of malfunction that could increase the risk of developing Parkinsons disease.
Treatment Of Parkinsons Disease
Theres currently no cure for PD. However, medications can help improve symptoms associated with the condition.
Levodopa, also called L-DOPA, is a drug that nerve cells can use to make dopamine. Levodopa is often given with carbidopa, which helps to prevent the medication from being converted to dopamine before it reaches the brain. Carbidopa-levodopa is available under the brand names Sinemet, Duopa, and Rytary.
Other types of drugs that may be given for PD include:
- Amantadine:Amantadine is an antiviral drug that may help treat the symptoms of PD as well as the side effects of PD treatments such as levodopa.
- Dopamine agonists:Dopamine agonists can mimic the role of dopamine in the brain.
- Monoamine oxidase inhibitor B inhibitors:MAO-B inhibitors work to block the activity of monoamine oxidase inhibitor B, a brain enzyme responsible for breaking down dopamine.
- Catechol-O-methyltransferase inhibitors: COMT inhibitors are similar to MAO-B inhibitors in that they work to block a brain enzyme that breaks down dopamine.
- Anticholinergics:Anticholinergics work to reduce the activity of the neurotransmitter acetylcholine and may help ease tremors.
When medications arent effective at managing PD symptoms, other treatment options may be recommended. These include deep brain stimulation and brain surgery.
A Note About Sex And Gender
Sex and gender exist on spectrums. This article will use the terms, male, female, or both to refer to sex assigned at birth. .
According to the Parkinsons Foundation, Parkinsons disease affects approximately 1 million people in the United States.
Females are less likely to develop the condition compared to males, and they may experience different symptoms.
Females report:
- Medications: The first-line medication to treat Parkinsons disease is levodopa.
- Surgery: This aims to reduce tremors and rigidity. It can include:
- lesion surgery, which targets deep parts of the brain that control movement.
- deep brain stimulation , where a surgeon places a small electrode on parts of the brain that control movement.
However, the Parkinsons Foundation suggests that females may not respond as well to treatment compared to males. Even small changes in the medications or medication schedules can lead to significant changes in the symptoms that females experience.
Females have a higher chance of developing involuntary muscle movement as a side effect of levodopa medication. This may be due to the following factors:
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Impact Of Biological Sex On Pd Pathophysiology
The distinctive clinical features as well as the contribution of different risk factors support the idea that PD development might involve distinct pathogenetic mechanisms in male and female patients. It is clear that estrogens play a preponderant role in the sex differences in PD, providing disease protection as demonstrated by the similar incidence of the disease in men and post-menopausal women. Moreover, it is noteworthy that sex hormones act throughout the entire brain of both males and females and sex differences are now highlighted in brain regions and functions not previously considered as subjected to such differences, opening the way to a better understanding of gender-related behavior and functions.
This section presents an overview of the most recent evidence corroborating the hypothesis of a sex-related PD pathophysiology, with a special focus on the role of estrogens .
Study Design And Participant Selection
A repeated cross-sectional study was conducted using data from the BNA from January 1, 2010, through December 31, 2015. Individuals who received one of the diagnoses of interest at least once during the study time frame were included in the analysis.
Individuals were included in the DLB group if the first DLB diagnosis was made between 2010 and 2015 and if the last diagnosis was DLB . Individuals with a first PD diagnosis between 2010 and 2015 and with PD or PDD as their last diagnosis were included in the PD group. Individuals with a first PDD diagnosis between 2010 and 2015 with PDD as their last diagnosis and who never had a PD diagnosis were included in the PDD group. Checking the last diagnosis of the patient was intended to increase the reliability of the diagnosis.
Individuals who had the diagnosis of interest already when first registered in the database were included only if their first consultation for memory troubles was in the same year or the year before the first visit. This was intended to exclude patients who had a diagnosis established for a long time and to collect data at the time of the first diagnosis.
To describe the whole population included in the study, we selected data at the first diagnosis of interest. Given the importance of cognitive status, only patients with at least one existing MMSE evaluation at less than 1 year before or after the first diagnosis of interest were considered in the analysis .
Fig. 1
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Motor Vs Nonmotor Symptoms
The motor, or movement-related, symptoms of Parkinsons disease tend to emerge earlier in males than in females.
Tremors, accompanied by falls, together with pain-related conditions with specific features such as unstable posture and reduced rigidity, are more likely to be among early symptoms in females.
Risk of movement complications resulting from treatment with levodopa to raise dopamine levels is also higher in females.
In contrast, males tend to experience more severe problems with posture. Although freezing of gait develops later than in females, males are at a higher risk of camptocormia, a condition in which the spine bends forward when walking and standing.
Ongoing research that is investigating other aspects of postural changes is also looking into sex differences.
A study of more than 950 people found that certain nonmotor Parkinsons disease symptoms were more common in females and affected them more severely. These symptoms include: restless legs, depression, fatigue, pain, constipation, weight change, loss of smell or taste, and excessive sweating.
Other investigations have shown that the reduction in mental capacity that can occur with Parkinsons disease tends to be worse in males.
These have demonstrated, for example, that males with Parkinsons are more likely to develop mild cognitive impairment and experience greater progression of it in the later stages of the disease. MCI is a condition that often precedes dementia.
Pharmacological Therapy Of Motor Symptoms
In the absence of a disease-modifying therapy, PD treatment is currently based on the control of motor symptoms by levodopa supplementation. However, long-term therapy with levodopa is associated with the development of motor complications, such as levodopa-induced-dyskinesia, wearing off and on-off phenomena. It is generally assumed that dyskinesia is associated with sustained levodopa plasma levels . Commonly, women present greater levodopa bioavailability, which is further supported by lower levodopa clearance levels . Dopamine bioavailability in the central nervous system is dependent on the activity of two catabolic enzymes: catechol-O-methyltransferase and monoamine oxidase-B , whose encoding genes are located on the chromosome 22 and X chromosome, respectively . A study that explored the relationship between MAO-B or COMT functional SNPs and levodopa therapy reported that male PD patients carrying the MAO-B G allele had a 2.84-fold increased risk of developing motor complications when treated with high doses of levodopa .
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Disease Predictors And Risk Factors
The etiology of PD is not well understood. Despite the presence of familial cases, PD is substantially an idiopathic, multi-factorial disease caused by the interplay between genetic and environmental factors. Genetic studies have identified increasing numbers of risk polymorphisms, whereas little is still known about environmental risk factors and how these affect PD risk.
Heinzel and coll. recently highlighted the sex-related differences in prodromal PD. They concluded that women and men show distinctive prodromal markers of PD , suggesting that these differences should be taken into account to guarantee the diagnostic accuracy of prodromal PD .
Causes Of Parkinson’s Disease
Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.
Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.
Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.
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Onset Progression And Mortality Of Parkinsons Disease In Men
Women on average develop the disease 2.1 years later than men. However, other studies have found no differences between men and women for the age of onset.3 One study that followed PD patients for six years found that despite the increased rate of PD in men, men and women acquired the disease at the same age and have the same progression and duration of disease. The study also found that men and women patients with PD have the same average life expectancy, which is different than in the general population without PD, in which women have a longer life expectancy than men.5
Symptoms of PD also tend to progress more rapidly in men. However, larger scale, placebo controlled studies are required for more conclusive evidence on the differences between women and men in the symptoms and treatment of PD.
What Are The Symptoms
The best-known symptoms of Parkinson’s disease involve loss of muscle control. However, experts now know that muscle control-related issues aren’t the only possible symptoms of Parkinson’s disease.
Motor-related symptoms
Motor symptoms which means movement-related symptoms of Parkinsons disease include the following:
Additional motor symptoms can include:
- Blinking less often than usual. This is also a symptom of reduced control of facial muscles.
- Cramped or small handwriting. Known as micrographia, this happens because of muscle control problems.
- Drooling. Another symptom that happens because of loss of facial muscle control.
- Mask-like facial expression. Known as hypomimia, this means facial expressions change very little or not at all.
- Trouble swallowing . This happens with reduced throat muscle control. It increases the risk of problems like pneumonia or choking.
- Unusually soft speaking voice . This happens because of reduced muscle control in the throat and chest.
Non-motor symptoms
Several symptoms are possible that aren’t connected to movement and muscle control. In years past, experts believed non-motor symptoms were risk factors for this disease when seen before motor symptoms. However, theres a growing amount of evidence that these symptoms can appear in the earliest stages of the disease. That means these symptoms might be warning signs that start years or even decades before motor symptoms.
Non-motor symptoms include:
Stages of Parkinsons disease
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Impact Of Female Hormones
A notable sex-related difference in Parkinsons disease concerns the impact of female hormones, such as estrogen, which seem to protect neurons.
The fact that males and postmenopausal females have similar risks of developing Parkinsons disease would appear to support this: Their levels of estrogen are lower than those of premenopausal females.
Sex hormones act throughout the entire brain of both males and females and sex differences are now highlighted in brain regions and functions not previously considered as subjected to such differences, opening the way to a better understanding of sex-related behavior and functions, says first study author Silvia Cerri, Ph.D.
She refers to evidence that suggests that age-related deterioration of glial cells, which support neurons, may contribute to the onset and progression of Parkinsons disease.
Since estrogens have anti-inflammatory properties, their actions throughout the lifespan could partially account for sex-related risk and manifestation of .
Silvia Cerri, Ph.D.
Parkinsons In Women Is Less Common
Parkinsons disease is a condition that affects the nervous system. In PD, nerve cells in the brain that make the neurotransmitter dopamine become damaged or die. When this happens, it leads to symptoms such as tremors, muscle stiffness, and slowed movement.
Your biological sex is an important risk factor for developing PD. When compared to women, 1.5 times as many men have PD.
Usually theres a physiological reason for a difference in disease between sexes. How does being female protect against PD? And do women and men experience PD symptoms differently? Continue reading to learn more.
- bradykinesia, or slowed movement
- changes in balance and posture
The symptoms of PD can vary greatly between individuals regardless of sex, and women may have different symptoms than men.
When women are first diagnosed, tremor is usually the dominant symptom. This form of PD is associated with a slower deterioration of motor functions, according to a 2020 study .
In contrast, the initial symptom in men is usually changes in balance or posture, which can include freezing of the gait and falling.
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How Is It Treated And Is There A Cure
For now, Parkinsons disease is not curable, but there are multiple ways to manage its symptoms. The treatments can also vary from person to person, depending on their specific symptoms and how well certain treatments work. Medications are the primary way to treat this condition.
A secondary treatment option is a surgery to implant a device that will deliver a mild electrical current to part of your brain . There are also some experimental options, such as stem cell-based treatments, but their availability often varies, and many aren’t an option for people with Parkinsons disease.
Parkinson’s Disease In Women And Men: What’s The Difference
Increasing evidence points to biological sex as an important factor in the development and phenotypical expression of Parkinsons disease . Risk of developing PD is twice as high in men than women, but women have a higher mortality rate and faster progression of the disease. Moreover, motor and nonmotor symptoms, response to treatments and disease risk factors differ between women and men. Altogether, sex-related differences in PD support the idea that disease development might involve distinct pathogenic mechanisms in male and female patients. This review summarizes the most recent knowledge concerning differences between women and men in PD clinical features, risk factors, response to treatments and mechanisms underlying the disease pathophysiology. Unraveling how the pathology differently affect the two sexes might allow the development of tailored interventions and the design of innovative programs that meet the distinct needs of men and women, improving patient care.
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Researchers Led By Ucla Health Call For More Work To Address Overlooked Issues Affecting Women With Parkinsons Disease
Researchers in a multi-institution study led by UCLA Health have identified several overlooked issues affecting women with Parkinsons Disease and call for more research, customized treatments, education and support to empower women living with this disease and to address their unmet medical needs. The study was done by an all women team, including three movement disorders specialists and other researchers, most of whom are living with PD. This summary of the study bullet points the researcher’s 8-point “Call to Action,” provides background, and the study methods. The study, titled Unmet Needs of Women Living with Parkinson’s Disease: Gaps and Controversies, was published in Movement Disorders, January 20, 2022. Included in this summary is a link to the abstract and the Wiley Online Library for access to the full text. Login through a subscribing institution or purchase instant access.
Parkinson’s Diva: A Woman’s Guide To Parkinson’s Disease
A personal and professional accounting of a young Parkinsons doctors experience with the disease in all realms of her life . . . from doctor, caregiver, and ultimately as a young Parkinsons patient herself. Dr. De León covers important basics of PD and research-based data and shares the personal concerns and gender-specific battles that young women who live with the disease must face. She encourages readers to be empowered through education, self-awareness, and faith.
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Parkinsons Strikes More Men Than Women Researchers Have Worked For Decades To Learn Why
J. William Langston, who has been studying and treating Parkinsons disease for nearly 40 years, always has found it striking that so many more men than women show up in his clinic. His observation is not anecdotal. It is grounded in science and shared by many physicians: Men are roughly 1.5 times more likely than women to develop Parkinsons, a progressive disorder of the nervous system that impairs movement and can erode mental acuity.
Its a big difference that is quite real, says Langston, clinical professor of neurology, neuroscience and of pathology at the Stanford University School of Medicine and associate director of the Stanford Udall Center. Its pretty dramatic. I think anyone who sees a lot of Parkinsons will tell you that.
While the disproportionate impact is clear, the reasons for it are not. Its a great mystery, Langston says. Researchers still dont know what it is that makes men more susceptible to Parkinsons, or what it is about women that may protect them or both. But they are trying to find out.
Parkinsons results from the death of key neurons in the substantia nigra region of the brain that produce the chemical messenger dopamine. Over time, the loss of these nerve cells disrupts movement, diminishes cognition, and can cause other symptoms, such as slurred speech and depression.
Such a Parkinsons study could do the same, she says.