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Contains fulltext : 53439.pdf (publisher's version ) (Closed access), OBJECTIVE: To investigate gender differences in basic disease characteristics, motor deterioration and nigrostriatal degeneration in Parkinson's disease (PD). METHODS: We studied 253 consecutive PD patients who were not receiving levodopa or dopamine agonists (disease duration < or = 10 years). We investigated the influence of gender and oestrogen status on: (1) age at onset, (2) presenting symptom, (3) severity and progression of motor symptoms (Unified Parkinson's Disease Rating Scale III (UPDRS-III) scores) and (4) amount and progression of nigrostriatal degeneration ([123I]FP-CIT single photon emission computed tomography measurements). RESULTS: Age at onset was 2.1 years later in women (53.4 years) than in men (51.3 years). In women, age at onset correlated positively with parity, age at menopause and fertile life span. Women more often presented with tremor (67%) than men (48%). Overall, patients presenting with tremor had a 3.6 year higher age at onset and a 38% slower UPDRS-III deterioration. Mean UPDRS-III scores at disease onset were equal for both genders, as was the rate of deterioration. Women had a 16% higher striatal [123I]FP-CIT binding than men at symptom onset and throughout the course of PD. CONCLUSIONS: Our results suggest that, in women, the development of symptomatic PD may be delayed by higher physiological striatal dopamine levels, possibly due to the activity of oestrogens. This could explain the epidemiological observations of a lower incidence and higher age at onset in women. Women also presented more often with tremor which, in turn, is associated with milder motor deterioration and striatal degeneration. Taken together, these findings suggest a more benign phenotype in women with PD.

Item does not contain fulltext, In this review, we relate both laboratory and clinical evidence associated with the capacity for estrogen to function as a modulator of nigrostriatal dopaminergic pathology. To accomplish this goal, we have divided this review into three parts. In Part 1, we provide a brief historical perspective of studies that have laid the groundwork for demonstrating the existence of hormonal- nigrostriatal interactions. In Part 2, we focus specifically on laboratory data that show the ability and conditions by which estrogen may function as a neuroprotectant of the nigrostriatal dopaminergic system. Finally, in Part 3, we review the clinical literature related to this issue as a means for consideration of estrogen as a modulator, neuroprotectant, and therapy for Parkinson disease.

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