Sex and Gender in Multidisciplinary PD Care 29 2 presenting more contamination/cleaning symptoms or eating disorders whereas men more commonly present with sexual and aggressive symptoms.(31,32) It remains to be investigated if these differences are due to different disease entities or simply to socially-acceptable gendered behaviours (Table 1). Depressive symptoms and anxiety are among the most common non-motor symptoms in people with PD.(33,34) Depressive symptoms and anxiety in PD are likely to be multifactorial, related to the influence of PD pathology and the indirect impact of impaired mobility and social isolation.(35,36) Sex differences in depression have been linked to differences in expression of susceptibility genes and hormonal influences as well as gender-related differences in reporting.(37,38) Although females and males with PD experience similar physical symptoms, the associated psychological burden appears to differ. Men primarily report difficulties in self-presentation, whereas women report greater psychological burden and larger impact on their intimate relationships.(39,40) This associates with a significant reduction in quality of life in women with PD.(41) Also, higher anxiety levels have been reported in women with PD, especially in the early clinical phase of the disease.(42–44). However, to date, the impact of sex and gender differences in anxiety and depressive symptoms on care provision for people with PD has remained limited. Again, the field of PD is not unique in this regard. In 2008, the masculine depression scale (MDS) was developed to facilitate diagnosis of masculine depressive symptoms.(45) A recent study found that men and women who endorse a masculine gender role are relatively more likely to display externalising symptoms (e.g., anger, somatic symptoms, using substance or sex to feel better) in response to negative life events, and less likely to report typical, internalising depressive symptoms, as measured by, e.g., the widely used Beck Depression Inventory (e.g., depressed mood or crying).(46) Therefore, clinicians should be aware that individuals who strongly adhere to masculine gender roles, whether they be men or women, might display different signs and symptoms and may respond differently to behavioural interventions for depression and anxiety than individuals who adhere more strongly to a feminine gender role (Table 1). Gender aspects in lifestyle Few differences in lifestyle between men and women with PD have been reported. In this section, we discuss two examples that highlight the potential impact of such differences on multidisciplinary care for people with PD: weight loss and physical activity. Progressive weight loss is common among people with PD , likely due to a combination of physical inactivity (causing muscle loss), lower intake of solid foods due to oropharyngeal dysphagia and a catabolic state.(15,47) A decreased intake of solid foods
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