Objective: To determine the sex differences for the frequency, duration, and impact of off episodes in Parkinson’s disease (PD).

Background: Dopamine replacement therapy through oral medications provides substantial symptomatic relief in PD. However, complications of oral medications, such as the wearing off phenomenon can occur with disease progression. Women have a higher risk for wearing-off earlier in the disease course than men. Both motor and non-motor symptoms can get worse during the off episodes and these episodes can occur up to several times a day, sometimes lasting a few hours with significant impact on daily life.

Method: The data was obtained from the Fox Insight database on Feb 1st, 2023. Women and men reporting a PD diagnosis that filled out the “Impact of Off Episodes” questionnaire were included (149 women, 149 men). The questionnaire includes items on frequency, duration, and impact of off episodes over the past week. Sex differences for off episode likelihood, duration, frequency, and impact were assessed.

Results: Women and men had similar mean age and disease duration (based on early, mid, later categories). Women were less educated than men (p=.002). Majority of the sample identified as non-Hispanic (96%) and White (98%). Overall, 63% of women and 68% of men experienced off episodes (p=.39). Out of people who reported experiencing off episodes (94 women, 101 men), women experienced off episodes more frequently (p=.003), although the average and total duration of off episodes were similar for women and men. Women reported more impact of off episodes in general (p=.028). Increase in disability rate in the off episodes compared to on episodes was significantly higher for women (p=.004). Women reported experiencing more pain and more difficulty with housework or cooking than men during off (p=.010, p=.003). There were no sex differences for off episode impacts on work tasks, getting around in public, walking safely, grooming, feeling depressed or anxious, problems with concentration, memory, communication, task switching.

Conclusion: For women and men with similar age and disease duration off episode frequency and impact can differ. Women can experience more impairment during off in certain domains, and addressing and preventing fluctuations may be more important for women.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sex-differences-for-off-episodes-in-parkinsons-disease/