In recent years, there has been an increasing interest in understanding how gender and sex may influence aging to improve elderly care. A personalized approach, accounting for these and other individual characteristics, is especially relevant in neurology since how a specific neurodegenerative disease is expressed can widely vary across patients. The variety in disease expression may influence different aspects, from prevention and diagnostic strategies to treatment.

In particular, it is well known that Parkinson’s disease (PD) is more prevalent in men than women and recent studies point out that symptoms could differ depending on the patient’s sex. For example, while men with PD are more likely to experience postural problems, gait difficulties, excessive drooling, and cognitive problems, women with PD tend to experience more tremors, falls, pain, difficulty in swallowing, visual deficits, and gastrointestinal issues. Some of these sex differences may be related to divergences in brain damage between men and women. In this sense, current evidence shows that after a recent diagnosis, men display more brain atrophy.

Thanks to an international collaboration between researchers at the University of Deusto (Bilbao, Spain), the University of Barcelona (Barcelona, Spain), the Center of Addiction and Mental Health (Toronto, Canada), and the University of Cologne (Cologne, Germany) we examined how the patient’s sex impacts brain structure in PD. We also posed the question of whether these relations between sex and brain atrophy are influenced by disease duration. Our collaboration resulted in the study “A multi-site study on sex differences in cortical thickness in non-demented Parkinson’s disease’’ recently published in npj Parkinson’s Disease.

To answer our questions, we examined structural brain imaging data from 211 individuals with PD within five years on average since they received the clinical diagnosis. We used an automated procedure to assess the cortical thickness, a well-known imaging marker to estimate brain atrophy in neurodegenerative diseases and aging.

Our analyses revealed that men with PD showed more brain atrophy than women with PD across some cortical brain regions. Moreover, disease duration seems more relevant to explain reduced cortical thickness in male patients. This result suggests worse prognostic over time and consequently different paths depending on sex.

Considering our findings, future studies could examine whether men and women with PD present different brain degeneration over time and how these differences are related to specific symptoms.  Discerning distinctive neurodegeneration trajectories is especially relevant for tracking the disease progression with greater precision, for example, in clinical trials testing new drugs.