Gender differences in the frequency and treatment of behavior problems in Parkinson's disease

OBJECTIVE: To determine gender differences in the prevalence, survival rate s, and management of noncognitive behavioral problems of patients with Park inson's disease (PD) in nursing homes (NH). METHODS: We performed an observational study on 24,402 residents with PD us ing the Systematic Assessment and Geriatric drug use via Epidemiology (SAGE ) database collected from the Minimum Data Set on a cross-section of over 4 00,000 NH residents in five US states. Gender differences in behavior were used to predict differences in pharmacologic and nonpharmacologic therapies using logistic regression. Similar analyses were done to evaluate gender d ifferences in 1-year survival rates among patients with PD with and without behavioral problems. RESULTS: 36% of men and 33% of women exhibited behavioral problems. Wanderi ng, verbal and physical abusiveness, and inappropriate behavior tended to b e more common in men, especially among PD residents with severe cognitive i mpairment. Hallucinations and delusions were equally prevalent between gend ers and depressive symptoms were more common in women. Regardless of behavi oral manifestation, men were more likely to receive antipsychotic drugs, wh ereas women were more likely to receive antidepressants. This gender differ ence in treatment was also widest among the severely demented group. Althou gh women lived longer, no difference in survival curves were noted between PD residents with and without behavioral problems. CONCLUSION: Gender appears to play an important role in determining the fre quency and treatment of behavioral problems of NH residents with PD.