Sex and Gender in Multidisciplinary PD Care 35 2 Discussion In this perspective paper, we highlight the potential impact of sex and gender on care for people with PD and identify key knowledge gaps that hamper immediate implementation of sex- or gender-sensitive approaches. The intersection between biological differences and social norms and behaviours highlights the complexity of individualised care. Although knowledge regarding the role of sex and gender in PD is increasing, the current state of evidence does not yet allow for specific recommendations for sex- and gender sensitive approaches for individual patients. In the case of PD, few studies have focused on the role of gender and the ones that did, lacked a clear definition of the concept of gender itself. Gender consists of several dimensions, such as identity, roles and relations, and these should be clearly defined and operationalised when embarking into its investigation.(72) As the previously described studies on quality of life demonstrated, gender rather than sex was predictive.(62) This is in line with findings in the field of cardiology and highlights the continuous nature of the concept opposed to the simple man/woman dichotomy.(73) More methodological precision in the analysis of sex and gender differences in PD will aid the transferability of the acquired knowledge into practical steps towards individualised care. Furthermore, while the prevalence of PD has typically been higher in men than in women in clinical studies, population-based studies which include door-to-door screening and validation have demonstrated a markedly smaller gender difference in the prevalence of PD.(3,74) This discrepancy suggests that women with PD are not being referred to clinical settings as readily as men. In fact, a previous study showed that there is a considerable delay in referral of women with PD to movement disorder specialists.(75) Furthermore, women are also underrepresented in clinical trials on PD and efforts to bridge this gender gap in future RCTs should be undertaken.(76) The present perspective has highlighted various areas in need of additional research. Gender-specific preferences and priorities in health care provision need to be further investigated. Which symptoms are more burdening for women and men with PD and which potential barriers exist towards optimal care provision? Are there genderspecific dimensions that contribute to long-term maintenance of quality of life? How do gender roles impact the patient´s choices and can addressing them affect coping strategies? Answers to these important questions could support further refinement of multidisciplinary care programs tailored specifically to the needs of people with PD and remove potential unconscious gender-specific barriers.
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