Sex and Gender in Multidisciplinary PD Care 27 2 Sex and gender aspects in PD Sex and gender aspects in motor features PD is primarily known as a clinical syndrome described as ‘Parkinsonism’, which entails bradykinesia in combination with at least one of the following: resting tremor, rigidity or postural instability.(11,12) As the disease progresses, people with PD are prone to develop fluctuations in motor impairments related to dopaminergic therapy, as well as to freezing of gait.(13) Several differences in motor features between men and women with PD have been reported and have been summarized elsewhere.(8,14,15) However, the relevance of these differences for care provision to people with PD remains largely unknown. The potential impact of sex or gender differences on multidisciplinary care for mobility impairments comes from other fields of medicine, such as recent recommendations for osteoporosis screening guidelines based on underlying sex differences.(16) Osteoporosis predominantly affects postmenopausal females(17) but also impacts many elderly males.(18,19) Given the higher mortality of men with bone fractures, several osteoporosis and endocrinology societies now recommend screening in all men above 65 or 70 years (19,20), but this recommendation is not routinely implemented in clinical practice.(16) Similarly, it is possible that sex or gender differences in the prevalence of common motor features in PD may influence clinical recommendations in the future. Now, however, several gaps in empirical evidence hamper development of such sex- and gender-sensitive guidelines. In Table 1, we highlight key questions that, once addressed, could guide the implementation of sex- and gender-sensitive approaches to care for people with PD. An illustration of the current gaps in knowledge is the recent observation that postural instability appears to be more common among women with PD than among men.(8,21) This observation is based on a few relatively small studies, rendering uncertainty on whether this reflects a true sex difference in the prevalence of this feature. If larger studies replicated this finding, it would encourage preferential referral of women with PD to a physiotherapist for preventive and symptomatic interventions, such as technology-assisted balance training. But for this selective referral to be effective, we also need insight on whether the effectiveness of symptomatic interventions differs between men and women with PD. Future studies should be adequately powered to examine clinically meaningful effect modification by gender, which requires larger sample sizes.
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