Chapter 2 28 Furthermore, knowledge about the impact of gender-specific differences in activities of daily living (ADL) among people with PD is relatively scarce. The available literature, however, suggests that causal influences on ADL may differ substantially by gender. For instance, women report greater difficulty shopping and cleaning compared to men with PD, highlighting not only the practical consequences of mobility impairment, but also its gendered dimension.(22) If these differences are replicated in other studies, this would encourage the development of gendersensitive targeted occupational therapy interventions for ADL impairment.(23) Taken together, empirical evidence for targeted care interventions which consider sex and gender differences in mobility impairment could eventually influence clinical guidelines for people with PD. An additional area of potential sex- or gender-related influences on care revolves around interactions between patients and healthcare professionals. In the field of surgery, two gender-related factors have affect the indication for total joint arthroplasty(24): less referral of women by their primary care physician, i.e. reflecting a potential bias on the side of the physician; and less requests by women to undergo surgery, i.e. bias on the side of the patient. A recent study suggests that women with PD are less likely to undergo Deep Brain Stimulation (DBS) surgery than men with PD.(25,26) This is of particular note given that the current literature suggests that women may experience a greater improvement in quality of life after DBS than men.(9,27) This imbalance needs to be further investigated to remove potential referral or request bias through targeted interventions on the provider or patient side. (26,28) Sex and gender aspects in non- motor features Although PD is widely (and inadvertently) perceived as being primarily characterized by motor symptoms, non-motor symptoms are actually at least as common, and importantly, these can have a considerable impact on quality of life in persons with PD. In this section, we discuss two examples that highlight the potential impact of sex and gender differences on multidisciplinary care for people with PD: impulse control disorders and depressive symptoms. Impulse control behaviours (ICBs) are associated with dopamine replacement therapy in PD. Overall, ICBs are generally more common in men compared to women with PD.(29) However, the direction of these differences might differ by the specific type ICB: hypersexuality and gambling are more common in men, while compulsive buying is more common in women.(30) Analogous differences have been reported for compulsive disorders in people without PD, with women
RkJQdWJsaXNoZXIy MTk4NDMw