Parkinson’s disease (PD) is a motor disorder characterised by the degeneration of the dopaminergic neurons in the nigrostriatal pathway of the basal ganglia.(1) It is the second most common neurodegenerative disease after Alzheimer’s Disease. Studies from the western populations have shown significant differences in the various features of the disease between the males and the females with regard to age of onset, progression and severity of the motor symptoms.(2),(3),(4) These are attributed to presumptive hormonal interactions between estrogens and dopamine. (2), (5) While numerous studies are available to support these findings from the western world, only a handful of such studies have been conducted from Northern India so as to test the validity of the hypothesis in our population.(6),(7)However with increased recognition of the Non motor symptoms (NMS) in PD it is becoming progressively more important to evaluate and study the gender differences among NMS (8). Studies from the Western population have shown increased prevalence of behavioural disorders and rigidity in men and increased dyskinesias and depression in women (5), (9). Studies also report increased sexual problems and taste and smell related abnormalities in males. (10)Men in general are found to be at greater risk for developing NMS than women.(11) However certain studies have also reported no gender differences among the NMS.(9)This study proposes to study the Gender differences for both the motor as well as the non motor symptoms in an Indian cohort of PD patients using the Unified Parkinson’s Disease Rating Scale  (UPDRS) and modified Hoen and Yahr criteria for the motor symptoms and the Non Motor Symptom assessment Scale for Parkinson’s ( NMSS)  for the non motor symptoms. The student researcher will be appropriately trained by a neurologist to administer these Questionnaires and data would be analysed by appropriate statistical methods.  This study would help to direct appropriate treatment to PD patients in our resource limited, manpower limited and healthcare limited scenario.OBJECTIVESThe study will aim to compare the gender differences in Indian PD patients with regard to the following features:Age of onset of the diseaseSeverity of motor symptoms based on UPDRS scaleFrequency and severity of Non motor symptoms in PD patients.METHODOLGYType of study: Cross sectional studyStudy population: All Patients attending the Neurology OPD of a tertiary care hospital diagnosed as Idiopathic Parkinson’s disease (IPD).Sample size: The exact sample size would be determined after the onset of the study depending upon the patients fitting the selection criteria outlined below. A minimum of 30 females and 30 males would be included in the study so that the study has sufficient power.Selection criteria:  All female patients with IPD and their age matched male controls with IPD who are:Consenting to participate in the studyHave adequate cognitive functions to efficiently undertake the administered questionnaire All other causes of Parkinsonism ruled out Sufficient language skills to communicate with the researchersData collection procedures and instruments used:The student researcher will be trained by the neurologist regarding the various aspects of PD over 2 to 3 consecutive sessions. They will then witness the administration of the Questionnaires to the patients by the neurologist over the next session. Finally they would administer the questionnaire to the patient themselves under the supervision of the neurologist. Following this all the data will be collected by the student researcher independently.Upon recruiting the patients in the study they would be explained the nature and purpose of the study in detail in a language understood to them. They would be asked to sign an informed conset form. Following this they would be administered two questionnaires and a Performa. The Performa will be used to collect general information regarding the patients and the disease including the demographic data, the age of onset of symptoms, presenting complaints upon onset and the medications being administered to them. To assess the stage of the disease and the motor symptoms the standard UPDRS questionnaire will be used. This is a unified scale consisting of 42 different questions with up to 5 options used to assess the severity of the symptom.The NMSS will be administered to document the non motor symptoms of the patients. It consists of 30 questions divided over 9 domains to evaluate severity and frequency of each non motor symptom.  This will be reflected as a final total score of disability between 0 (no disability) to 360 (maximum disability). Both the questionnaires have been uploaded along with the proposal.Confidentiality: Strict confidentiality of all the personal information of the participants will be maintained and no additional personal information regarding the patients will be made available to a third party without the prior consent of the patient.Plan of analysis: Statistical analysis of the collected data will be done by a trained statistician using appropriate methods. It will aim to detect any significant differences in the various manifestations between male and female PD patients with a special emphasis on the Non Motor symptoms. The mean score of NMSS of female patients will be compared with the mean value of NMSS of their age matched controls. A p value of <0.05 (Confidence interval = 95%) will be considered as statistically significant.Ethical ConsiderationsPrior clearance from the Institutions Ethical Committee will be obtained before the commencement of the study.IMPLICATIONSIn terms of the knowledge gained, the student researcher will learn how to organise and conduct a scientific research, appropriately collect data and analyse it using statistical knowledge. The student will also learn about the various modalities of the disease and gain valuable clinical knowledge.The study would also help by providing useful demographic data for PD and encourage further research that may be conducted on a bigger scale 


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