From Motor Issues to Smell Loss: How PD Traits Vary by Sex
In a retrospective analysis of nearly 11,000 patients with Parkinson’s disease, women have more motor complications and depression, whereas men have more cognitive decline and olfaction loss.
SEOUL, South Korea — Many Parkinson’s disease (PD) symptoms — including motor complications, mood change, cognitive impairment, and even smell dysfunction — differ significantly between men and women, new research showed. In a retrospective analysis of nearly 11,000 patients with PD, women had a greater burden of motor complications and more commonly had depression .
Men had a greater prevalence of probable rapid eye movement sleep behavior disorder (RBD), greater cognitive decline, and greater olfaction loss. There were no significant between-group differences for age of onset of the disorder or disease duration. Co-investigator Sandrina Weber, MD, neurologist in Göttingen, Germany, told Medscape Medical News what really stood out for her was the stronger burden of motor symptoms found in women.
“Parkinson’s in every person is different, but stratifying according to sex is important. As clinicians, we should be asking about these symptoms,” she said. Weber presented the findings on October 5 at the International Congress of Parkinson’s Disease and Movement Disorders (MDS) 2026.
‘Real-World Cohort’ Sex differences in PD have long been overlooked, Weber said, even though studying them could clarify how disease presentation and treatment response vary between men and women. Large-scale studies remain few, she added. PD has often been thought of “as a disease for older men,” Weber said, “so we wanted to look specifically at the differences between the sexes in patients with PD.” The retrospective study analyzed data collected from 2009 to 2019 at a movement disorders clinic in Germany.
In the overall cohort of 10,943 consecutive patients with PD, 6508 were men. The mean age was 70.7 years for women and 70.4 years for men. The Unified Parkinson’s Disease Rating Scale (UPDRS) was used to assess motor symptoms and complications, the Mini-Mental State Examination (MMSE) measured cognition, and the 12-item Sniffin’ Stick identification test was used to measure olfaction.
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Depression and RBD were assessed from the patients’ history and medical charts. Results showed no differences between women and men in age at PD onset (63.6 vs 63.4 years) or in disease duration (7.2 vs 7.0 years). There was also no difference in mean subscores on the UPDRS-I, II, or III.
However, the female participants had a significantly higher mean score on the UPDRS-IV than men (4.3 vs 3.5; P < .001), as well as higher incidence of depression (7.8% vs 4.2%; P < .001). Under the category of UPDRS-IV items, women had greater duration, disability, pain, and early morning dystonia in dyskinesia ( P < .001 for all).
For fluctuations, they also reported more appearances of predicable OFF ( P = .002), unpredictable OFF ( P < .001), and sudden-onset OFF ( P < .001). Male participants, on the other hand, had more prevalence of probable RBD (9.2% vs 6.2%; P = .02), worse cognition scores on the MMSE (24.9 vs 25.4; P < .001), and poorer olfaction (5.5 vs 6.4; P < .001).
“These findings highlight important sex-related differences in a real-world PD cohort,” the investigators noted in their abstract. “Ongoing analyses incorporating treatment data will help clarify the drivers of these differences,” they added. Boosting Precision Medicine?
Among the study’s strengths were the large dataset used and the analysis of a broad range of symptoms, session co-moderator Sirwan Darweesh, MD, PhD, associate professor and movement disorders neurologist at Radboud University Medical Center, Nijmegen, Netherlands, told Medscape Medical News .
The study also had some novel findings, especially around dyskinesia, he added. “I think the core question underlying all of these sex differences is: What are the mechanisms? And are these purely biological differences, which could be related to hormonal differences, or are these behavioral gender differences, either by the person with Parkinson’s or the physician treating them?” Darweesh asked.
The results also highlight the importance of considering sex differences when deciding on a tailored PD treatment approach or when designing clinical trials, Marina Picillo, MD, PhD, from the Center for Neurodegenerative Diseases at the AOU San Giovanni di Dio and Ruggi d’Aragona, Salerno, Italy, noted in a release.
“This would be the very first, basic step for boosting precision medicine in PD,” said Picillo, who was not involved with the research. The study was funded by the University Medical Center Göttingen. Weber reported receiving a speaker’s fee from Bial.
Darweesh reported no relevant financial disclosures.
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