To determine whether there are gender disparities in dysautonomia treatment among patients with Parkinson’s disease (PD).

Dysautonomia is a well-known complication of PD impacting quality-of-life. Gender disparities are associated with some aspects of PD care but whether this extends to dysautonomia treatment is not known.

Data were obtained from Parkinson Progression Markers Initiative (PPMI), a multicenter observational study. Gender, Scales for Outcomes in Parkinson’s Disease-Autonomic (SCOPA-AUT) scores (a patient-reported measure of dysautonomia), and names of medications indicated for dysautonomia treatment were extracted from year 5 data for PD subjects. Proportion of subjects treated with any medication for dysautonomia, and specific indications for treatment, were compared between genders using chi-squared analysis. Gender distribution was compared between SCOPA-AUT tertiles or SCOPA-AUT subdomain groups using 1-way analysis of variance by ranks. Logistic regression analysis was used to determine impact of gender on odds of treatment.

Gender distribution was not significantly different between any SCOPA-AUT tertiles or SCOPA-AUT subdomain groups. However, a significantly higher proportion of men than women was on any dysautonomia medication (p=0.022), a medication to treat urinary dysfunction (p<0.010), or a medication to treat sexual dysfunction (p<0.010). The odds of receiving treatment was significantly higher in men than women, even when controlled for SCOPA-AUT (OR=1.68, p=0.044, CI=1.01-2.77).

Despite similar prevalence of dysautonomia, men with PD are more likely to be treated for dysautonomia than women, particularly for urinary or sexual dysfunction. This is likely multifactorial but could relate to differences in likelihood for physicians to screen for symptoms based on gender. Awareness of gender disparities in treatment of PD-related dysautonomia is critical in ensuring optimized prescribing across all groups for this common and impairing complication of PD.