Lubomski Michal, Louise Rushworth R, Lee Will, Bertram Kelly L, Williams David R
The University of Notre Dame Australia, School of Medicine, Sydney, NSW, Australia.
Van Cleef Roet Centre for Nervous Diseases, Monash University, Melbourne, VIC, Australia; Neuroscience Department, Level 4 Centre block, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia.
J Clin Neurosci. 2014 Sep;21(9):1503-6. doi: 10.1016/j.jocn.2013.12.016. Epub 2014 Apr 24.
Sex-related differences in Parkinson's disease (PD) have been recognised, but remain poorly understood. We aimed to further clarify real-life differences in disease experience according to sex, by evaluating quality of life (QoL), demographic and clinical characteristics of PD patients. A cross-sectional survey was conducted on 210 PD patients (129 men, 81 women) attending specialist neurological clinics across three centres. Outcome measures included the motor examination of the Unified Parkinson's Disease Rating Scale (UPDRS-III) and QoL as measured by the 39-item Parkinson's Disease Questionnaire (PDQ-39). A male to female ratio of 1.6:1 was observed. Men reported a greater disease burden than women as noted by higher UPDRS-III scores (27 ± 13 versus 23 ± 13, p=0.032), daily levodopa equivalent doses (898.1 ± 481.3mg versus 750.7 ± 427.2mg, p=0.037) and caregiver reliance (44% versus 29.5%, p=0.039). The UPDRS-III score was significantly associated with sex after controlling for age and disease duration, with men more severely affected (β=-0.165, r(2)=0.101, p=0.028). The PDQ-39 showed men reported lower QoL in activities of daily living (ADL), cognition and communication sub-scales (p<0.05). An association was identified in men between PDQ-39 ADL and cognition sub-scales (r=0.660, p<0.001). Men with an appointed caregiver had a higher PDQ-39 Summary Index (t=3.222, degrees of freedom=122, p=0.002). PD was found to have greater overall impact on the health and well-being of male patients in sub-specialty clinical practice. Our study further supports the need for increased sex-delineated clinical assessment and consideration of potential differences required in the management of PD.
帕金森病（PD）的性别差异已得到认可，但仍了解不足。我们旨在通过评估PD患者的生活质量（QoL）、人口统计学和临床特征，进一步阐明根据性别在疾病体验方面的实际差异。对来自三个中心专科神经科诊所的210名PD患者（129名男性，81名女性）进行了横断面调查。结果指标包括统一帕金森病评定量表（UPDRS-III）的运动检查以及由39项帕金森病问卷（PDQ-39）测量的QoL。观察到男女比例为1.6:1。男性报告的疾病负担比女性更重，如UPDRS-III得分更高（27±13对23±13，p=0.032）、每日左旋多巴等效剂量更高（898.1±481.3mg对750.7±427.2mg，p=0.037）以及对照料者的依赖程度更高（44%对29.5%，p=0.039）。在控制年龄和病程后，UPDRS-III得分与性别显著相关，男性受影响更严重（β=-0.165，r²=0.101，p=0.028）。PDQ-39显示男性在日常生活活动（ADL）、认知和沟通子量表中的QoL较低（p<0.05）。在男性中，PDQ-39的ADL和认知子量表之间存在关联（r=0.660，p<0.001）。有指定照料者的男性的PDQ-39综合指数更高（t=3.222，自由度=122，p=0.002）。发现在专科临床实践中，PD对男性患者的健康和幸福的总体影响更大。我们的研究进一步支持了增加按性别划分的临床评估以及考虑PD管理中所需潜在差异的必要性。
