Uncovering Specific Influences on HRQOL in PD Patients by Gender in China

Researchers sought to discover if a study specific to China would show similar patterns in health-related quality of life (HRQOL) between male and female patients with Parkinson disease (PD).

Noting that most of the research on gender difference in Parkinson disease (PD) comes from other countries, a team of researchers in China recently sought to explore how these differences play out in a Chinese population.

Compared with women, men have higher a prevalence and incidence of PD, earlier onset, more severe motor symptoms, and more frequent cognitive decline. Some studies have indicated that the impact on quality of life (QOL) appears to be somewhat better for women, at least outside Asia. But there are limited studies on sex differences in health-related QOL (HRQOL) in patients with PD in China, and the disease is rising there, amounting to about 23% of cases worldwide. The authors said a better understanding of gender differences is important to personalize PD treatments.

The authors conducted a cross-sectional study from April 2020 to July 2021 in Beijing Rehabilitation Hospital on 162 patients, evaluating HRQOL, motor symptoms, and nonmotor symptoms. Of the 162 patients, 70 were male and 92 were female. Males were on higher daily doses of levodopa.

Inclusion criteria were a diagnosis of idiopathic PD diagnosed by a neurologist according to the Movement Disorder Society criteria; Hoehn and Yahr (H&Y) stage I–III stages; no deep brain stimulation or in vivo implantation treatment; and being able to understand and sign consent.

Differences of demographic, motor symptom assessments, nonmotor symptoms assessment, and QOL between males and females were assessed using t-test statistics, Mann–Whitney–Wilcoxon test, or χ2 depending on the data type.

Linear regression models were used to sort out the effect of gender.

Researchers did not see differences between male and female patients in the H&Y stage; Unified Parkinson's Disease Rating Scale parts I, II, III, and IV scores; tremor subscore; rigidity subscore; bradykinesia subscore; axial subscore; dyskinesia score; motor fluctuations score; Montreal Cognitive Assessment (MoCA) for cognitive function; or scores for fatigue, impulsive-compulsive disorders, and constipation.

The only statistical differences were seen in the levodopa equivalent daily dose, Hamilton Anxiety Rating Score, REM sleep behavior disorder sleep questionnaire, and Hyposmia Rating Scale score. Men had worse sleep and olfactory effects compared with women, while women were scored worse for anxiety.

Researchers used the PD Questionnaire-39 (PDQ-39) to evaluate HRQOL; the PDQ-39 is a validated disease-specific HRQOL measure with 8 dimensions assessing problems with mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort. Each item of the PDQ-39 is scored on a 5-point scale from “never” to “always.”

After correcting for imbalances, a significantly higher score was observed in female patients compared with male (P <.05). Females scored poorly on
bodily discomfort, stigma, and emotional well-being.

Their findings were in line with previous studies, the researchers said. One possible explanation for the findings is that anxiety negatively affects QOL and in this study, female patients had more severe anxiety. They also had more depression and apathy than male patients. The authors also hypothesized that the female burden of housework in China may have had an impact on the results.

“When we manage female PD patients, we should pay more attention to bodily discomfort, stigma, and emotional well-being for improving the QoL and inform the family members and caregivers to actively participate in the daily family activities to reduce the living burden of patients, and reduce the psychological burden of patients through positive psychological counseling and health education,” the authors concluded.


Meng D, Jin Z, Gao L, et al. The quality of life in patients with Parkinson's disease: focus on gender difference. Brain and Behavior.
Published online February 9, 2022.doi:10.1002/brb3.2517