Sex and Gender in Multidisciplinary PD Care 25 2 Introduction Sex and gender impact disease incidence, progression and provision of care in different medical disciplines.(1) “Sex” differences are based on biological variations due to differences in genetics, hormones and physiology. “Gender” differences are rooted in different expressions of identity, adherence to norms and socially defined behaviours. (2) Sex can impact the biological bases of disease progression, response to diagnostics and therapies, while gender can influence access to healthcare, coping with disease, compliance with therapies and patient-provider communication. Taken together, these aspects warrant consideration in the provision of care to people living with a disease. The influences of sex and gender on care delivery are especially relevant for chronic diseases that are characterized by a heterogeneous and progressive spectrum of clinical features. A prime example of such a disease is Parkinson’s disease (PD), which is the second most common neurodegenerative disease worldwide and which demonstrates a rapidly rising prevalence.(3) PD is partially characterized by motor features, but affected persons typically also experience a highly variable combination of non-motor features. Given the multifaceted and heterogenous nature of the disease, care delivery to people with PD typically involves healthcare professionals from a wide range of different professional disciplines to accommodate the specific clinical features, needs and coping styles of a person with PD.(4–7) Ideally, any person with PD should be treated by a diverse, multidisciplinary team, consisting of a general practitioner, neurologist, PD nurse specialist, physiotherapist, occupational therapist, speech- and language therapist, neuropsychologist, dietician or other healthcare professionals, depending on the needs of the patient.(7) At the time of clinical diagnosis, differences in the prevalence of motor and non-motor features might exist between men and women with PD. For instance, men might experience more rigidity and women more tremor.(8) As the disease progresses, sex and gender differences can emerge in the incidence of clinical features, such as postural instability or depressive symptoms (8,9). In addition to these differences in clinical phenotype, coping styles may also vary between men and women with PD.(10) Given this broad spectrum of potential differences, the consideration of sex- and genderspecific problems and needs of people with PD appears to be essential to provide personalised care. However, to date, empirical insight on the influence of sex and gender on disease progression and care for people with PD remains scarce. This perspective paper addresses how sex and gender may impact care for people with PD, drawing from both the PD literature as well as from other fields of medicine. We will specifically focus on the following domains: 1) motor features, 2) non-motor features,
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