In the United States, nearly 1 million individuals struggle with Parkinson’s disease (PD), a debilitating neurologic condition that gradually affects the brain’s ability to regulate movement. With about 60,000 new diagnoses reported each year and a projected 1.2 million cases by 2030, medical specialists are increasingly trying to identify PD’s underlying causes and particularities.
When analyzing Parkinson’s effects on different demographics, the fact that men are 1.5x more prone to developing the condition than women was an obvious discrepancy that sparked interest in PD’s gender-specific manifestation. However, the results are not always clear-cut.
Parkinson’s Expression in Women
While seemingly facing lower risks than men, 400,000+ US women live with PD. However, this number is extrapolated from the total number of PD fatalities, which fails to account for new diagnoses and doesn’t always accurately report causes of death. Though the lack of gender-specific Parkinson’s research may be discouraging, the limited available studies provide some insight into the condition’s effects on women.
A recent study suggests that estrogen, which plays a vital role in neuroprotection, is also responsible for promoting dopamine production and reducing oxidative stress that prevents inflammation commonly associated with PD. Although reporting symptoms at earlier ages and suffering from a milder version with reduced movement deterioration, women with longer fertile periods and later menopause face lower risks of developing Parkinson’s.
On the other hand, women also encounter distinct challenges and are more likely to downplay PD symptoms severity, leading to delayed diagnoses and referrals to specialists. Despite reports of better outcomes following the procedure than men, women with PD are less likely to receive deep brain stimulation due to frequent misdiagnosis. They also tend to report higher levels of psychological distress.
Levodopa is the go-to treatment option for Parkinson’s. Still, considering women’s lower average weight, age of onset, and the dosage more appropriate for men’s body masses, it makes Levodopa less effective as a female-oriented solution. Due to these inconsistencies, healthcare providers must often fine-tune their prescriptions to accommodate gender-specific factors.
Unregulated Substances Increase Environmental Risks
In addition to expected biological and genetic factors, exposure to man-made toxins is believed to affect Parkinson’s distinct development in men and women. While harmful chemicals like polychlorinated biphenyls (PCBs) and trichloroethylene (TCE) face stringent restrictions, other toxic substances widely utilized in intensive industries are not subject to similar regulations.
Paraquat, a highly toxic herbicide, is one such hazard that has been banned in over 60 countries due to its status as a PD risk factor. Despite broad international restrictions, paraquat is still widely used in US agriculture, with the EPA downplaying the herbicide’s relation to Parkinson’s and even reapproving it until 2035.
In 2018, California used roughly 30% of the 4.2 million pounds of paraquat applied across the US. That same year, California had the highest reported number of Parkinson’s cases (85,100). It was closely followed by a couple of other states that reported an increased number of PD diagnoses (Florida – 64,000, Texas – 52,500, New York – 48,000) and likewise applied paraquat extensively.
Almost 3 million US farmworkers and surrounding agricultural communities face higher risks of toxic herbicide exposure due to overreliance on chemical hazards like paraquat. While men are more likely to come directly into contact with the substance during its mixing, application, and clean-up, women are indirectly exposed during planting and harvesting. Additionally, agricultural workers may unintentionally carry traces of paraquat indoors on their persons or clothing.
Raising Awareness of Women’s Unique Struggles with PD
Due to the mistaken belief that Parkinson’s is primarily a male-oriented risk, PD-like symptoms are often overlooked in women, which probably explains why it takes 61% longer to receive a correct diagnosis and be referred for specialist treatment. Improving the condition of women struggling with Parkinson’s and dispelling detrimental commonly-held beliefs requires broader institutional involvement and a wider awareness of gender-specific issues.
While PD’s effects are indiscriminate, women displaying early or moderate symptoms tend to feel more pain than men and have a higher likelihood of experiencing psychological symptoms before any motor dysfunctions set in. For this reason, women reporting signs of Parkinson’s before menopause should closely monitor their hormonal cycle and their symptoms’ progression.
Physicians should factor gender variables into diagnosing Parkinson’, allowing them to prescribe suitable solutions that account for women’s characteristics and provide better access to subspecialty care or therapies like deep brain stimulation. Increasing women’s representation in clinical Parkinson’s studies will enable healthcare specialists to identify gender-specific risk factors and develop better treatment options. Meanwhile, the EPA can contribute to mitigating PD-related risks by efficiently regulating or restricting the use of hazardous pesticides associated with the condition’s development.
References:
https://www.nature.com/articles/s41531-018-0058-0
https://www.semanticscholar.org/paper/Epidemiology-of-Parkinson’s-disease.-Elbaz-Carcaillon/04e53239e3596afc902025cca11887dced8638e2
https://www.parkinson.org/blog/science-news/women
https://www.ajmc.com/view/large-study-finds-parkinson-disease-us-death-rate-soared-63-over-20-years
https://content.iospress.com/articles/journal-of-parkinsons-disease/jpd191683
https://www.nature.com/articles/s41531-020-0109-1
https://link.springer.com/article/10.1007/s10654-020-00672-x
https://pubmed.ncbi.nlm.nih.gov/25685848/
https://www.researchgate.net/publication/362777138_Agriculture_without_paraquat_is_feasible_without_loss_of_productivity_Lessons_learned_from_phasing_out_a_highly_hazardous_herbicide
Click to access pur_2018_subtotals_chemical.pdf
https://www.sciencedirect.com/science/article/abs/pii/S155085791100074X?via%3Dihub
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