MURAT İLHAN ATAGÜN, Birgül ATMACA, Feriha ÖZER, Serkan ÖZBEN, Raziye TİRAŞ, Sibel ÇETİN, Mehmet Fazıl GENÇ

Determinants of sexual dysfunction in male and female patients with parkinson’s disease

Amaç: Parkinson hastalığının (PH) karmaşık doğası ve farklı cinsel fizyolojileri nedeni ile kadın ve erkek hastalar, farklı biçimlerde cinsel işlev bozukluğu yaşıyor olabilirler. Bu çalışmada amaç, Parkinson hastası kadın ve erkeklerde cinsel işlev bozukluklarının belirleyicilerinin araştırılmasıdır. Yöntem: İdiyopatik PH olan ve ayakta tedavi gören 79 hasta (yaş ortalaması 67.51±8.27 olan 46 erkek, 33 kadın) Aralık 2007 ile Şubat 2011 tarihleri arasında çalışmaya alındı. Bileşik Parkinson Hastalığı Derecelendirme Ölçeği, Hoehn-Yahr Evrelemesi, Hamilton Depresyon ve Anksiyete Derecelendirme Ölçekleri, Kısa Akıl Muayenesi ve Arizona Cinsel Yaşantılar Ölçekleri ölçüm aygıtlarıydı. Bulgular: Yaş ve anksiyete çalışmaya dahil edilen tüm hastalarda, hastalık başlangıç yaşı ve anksiyete kadın hastalarda, yaş ve motor semptomların şiddeti erkek hastalarda cinsel işlev bozukluklarının belirleyicileriydi. Sonuç: Gonadal steroidler yaşın ilerlemesiyle birlikte, hem erkeklerde hem kadınlarda azalır. Dopamin cinselliğin; istek, sertleşme ve ödül arama davranışı gibi birimlerinde görev alır. Dopamin azalması, erkek hastalarda sertleşme bozukluğuna neden olur ve motor işlevleri etkileyerek, cinsel işlev bozukluğuna yol açar. Anksiyete, kendini algılama ve etkilenmiş beden imajına bağlı olarak gelişir ve erkeklere göre kadınları daha fazla etkiler

Parkinson hastalığında cinsel işlev bozukluklarının kadın ve erkek hastalarda belirleyiciler

Objective: Due to the complex nature of Parkinson’s disease (PD) and distinct sexual physiologies, male and female patients might have different patterns of sexual dysfunction (SD) in PD. The aim of this study was to assess determinants of SD in female and male patients with PD. Methods: Seventy nine outpatients with idiopathic PD (46 male, 33 female; mean age: 67.51±8.27) were recruited between December 2007 and February 2011. Unified Parkinson’s Disease Rating Scale and Hoehn– Yahr stages, Hamilton depression and anxiety scales, Mini-Mental State Examination and Arizona Sexual Experiences scale were the measures. Results: Determinants of SD in the whole group were age and anxiety. Age at disease onset and anxiety designated SD in female group, while age and severity of motor symptoms designated SD in male group. Conclusion: Both in males and females, gonadal steroids decline with advancing age. Dopamine has role in desire, erection, reward-seeking behavior phases of sexuality. Dopamine depletion may cause SD with its dual effects, including erectile dysfunction as well as motor disturbances in PD in male patients. Anxiety effect females more than males due to affected body image and perception of the self.

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1. Fearnley JM, Lees AJ. Ageing and Parkinson’s disease: substantia nigra regional selectivity. Brain 1991; 114:2283–2301.
2. Mulligan T, Retchin SM, Chinchilli VM, Bettinger CB. The role of aging and chronic disease in sexual dysfunction. J Am Geriatr Soc 1988; 36:520-524.
3. Koller WC, Vetere-Overfield B, Williamson A, Busenbark K, Nash J, Parrish D. Sexual dysfunction in Parkinson’s disease. Clin Neuropharmacol 1990; 13:461-463.
4. Basson R. Sexuality and Parkinson’s disease. Parkinsonism Relat Disord 1996; 2:177-185.
5. Welsh M, Hung L, Waters CH. Sexuality in women with Parkinson’s disease. Mov Disord 1997; 12:923-927.
6. Wermuth L, Stenager E. Sexual problems in young patients with Parkinson’s disease. Acta Neurol Scand 1995; 91:453-455.
7. Lipe H, Longstreth WT Jr, Bird TD, Linde M. Sexual function in married men with Parkinson’s disease compared to married men with arthritis. Neurology 1990; 40:1347-1349.
8. Jacobs H, Vieregge A, Vieregge P. Sexuality in young patients with Parkinson’s disease: a population based comparison with healthy controls. J Neurol Neurosurg Psychiatry 2000; 69:550- 552.
9. Drench ME, Losee RH. Sexuality and sexual capacities of elderly people. Rehabil Nurs 1996; 21:118-123.
10. Brann DW, Dhandapani K, Wakade C, Mahesh VB, Khan MM. Neurotrophic and neuroprotective actions of estrogen: basic mechanisms and clinical implications. Steroids 2007; 72:381- 405.
11. Craig MC, Murphy DG. Estrogen: effects on normal brain function and neuropsychiatric disorders. Climacteric 2007; 10 (Suppl.2):97-104.
12. Lynch WJ, Roth ME, Carroll ME. Biological basis of sex differences in drug abuse: preclinical and clinical studies. Psychopharmacology (Berl) 2002; 164:121-137.
13. McEwen BS, Alves SE. Estrogen actions in the central nervous system. Endocr Rev 1999; 20:279-307
14. Toran-Allerand CD. Estrogen and the brain: beyond ER-alpha, ER-beta and 17 beta-estradiol. Ann N Y Acad Sci 2005; 1052:136- 144.
15. Rajput AH, Offord KP, Beard CM, Kurland LT. Epidemiology of parkinsonism: incidence, classification, and mortality. Ann Neurol 1984; 16:278-282.
16. Celikel E, Ozel-Kizil ET, Akbostancı MC, Cevik A. Assessment of sexual dysfunction in patients with Parkinson’s disease: a case-control study. Eur J Neurol 2008; 15:1168-1172.
17. Sakakibara R, Shinotoh H, Uchiyama T, Sakuma M, Kashiwado M, Yoshiyama M, et al. Questionnaire-based assessment of pelvic organ dysfunction in Parkinson’s disease. Auton Neurosci 2001; 92:76-85.
18. Lucon M, Pinto AS, Simm RF, Haddad MS, Arap S, Lucon AM, et al. Assessment of erectile dysfunction in patients with Parkinson’s disease. Arq Neuropsiquiatr 2001; 59:559-562.
19. Brown RG, Jahanshahi M, Quinn N, Quarrington B. Sexual function in patients with Parkinson’s disease and their partners. J Neurol Neurosurg Psychiatry 1990; 53:480-486.
20. Singer C, Sanchez-Ramos J, Weiner WJ, Ackerman M. Sexual dysfunction in parkinsonian males. Neurology 1989; 3:145.
21. Macht M, Schwarz R, Ellgring H. Patterns of psychological problems in Parkinson’s disease. Acta Neurol Scand 2005; 111:95-101.
22. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17:427-442.
23. Fahn S, Elton R. Unified Parkinson’s disease rating scale: In Fahn S, Marsoen CD, Calne D, Goldstein M (editors). Recent developments in Parkinson’s disease. New Jersey: MacMillian Healthcare Information, 1987, 153-163.
24. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23:56-62.
25. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32:50-55.
26. Folstein MF, Folstein S, Mc Hugh PR. ’Mini mental state: a practical method for grading the cognitive state of patient for the clinician. J Psych Res 1975; 12:189-198.
27. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Reliability and validity of the standardized mini mental state examination in the diagnosis of mild dementia in Turkish population. Turk Psikiyatri Derg 2002; 13:273-181.
28. McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL. The Arizona Sexual Experience Scale (ASEX): Reliability and validity. J Sex Marital Ther 2000; 26:25-40.
29. Soykan A. The reliability and validity of Arizona sexual experiences scale in Turkish ESRD patients undergoing hemodialysis. Int J Impot Res 2004; 16:531-534.
30. Lindau S, Schumm P, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. New Engl J Med 2007; 357:762-774.
31. Atagün İ, Mutlu A, Özer F, Atmaca B, Çetin S. Relationship between dopaminergic treatment and sexual behavior in Parkinson’s disease. Journal of Parkinson’s Disease and Movement Disorders 2010; 13:29-35.
32. Shulman LM. Gender differences in Parkinson’s disease. Gend Med 2007; 4:8-18.
33. Chagas MHN, Tumas V, Loureiro SR, Correa ACR, Nakabayashi TIK, Crippa JAS. Does the association between anxiety and Parkinson’s disease really exist? A literature review. Curr Psychiatry Rev 2009; 5:29-36.
34. Rahman S, Griffin HJ, Quinn NP, Jahanshahi M. Quality of life in Parkinson’s disease: the relative importance of the symptoms. Mov Disord 2008; 23:1428-1434.
35. Krummer A, Cardoso F, Teixeria AL. Generalized anxiety disorder and the Hamilton Anxiety Rating Scale in Parkinson’s disease. Arq Neuropsiquiatr 2010; 68:495-501.
36. Yu M, Roane DM, Miner CR, Fleming M, Rogers, JD. Dimensions of sexual dysfunction in Parkinson’s disease. Am J Geriatr Psychiatry 2004; 12:221-226.
37. Jenkins RB, Groh RH. Mental symptoms in Parkinsonian patients treated with L-dopa. Lancet 1970; 2:177-179.
38. Tandberg E, Larsen JP, Aarsland D, Cummings JL. The occurrence of depression in Parkinson’s disease. A community-based study. Arch Neurol 1996; 53:175-179.
39. Siemers ER, Shekhar A, Quaid K, Dickson H. Anxiety and motor performance in Parkinson’s disease. Mov Disord 1993; 8:501- 506.
40. Stein MB, Heuser IJ, Juncos JL, Uhde TW. Anxiety disorders in patients with Parkinson’s disease. Am J Psychiatry 1990; 147:217-220.
41. Menza MA, Robertson-Hoffman DE, Bonapace AS. Parkinson’s disease and anxiety: comorbidity with depression. Biol Psychiatry 1993; 34:465-470.
42. Hughes TA, Ross HF, Mindham RH, Spokes EG. Mortality in Parkinson’s disease and its association with dementia and depression. Acta Neurol Scand 2004; 110:118-123.
43. Tumas V, Rodrigues GG, Farias TL, Crippa JA. The accuracy of diagnosis of major depression in patients with Parkinson’s disease: a comparative study among the UPDRS, the geriatric depression scale and the Beck depression inventory. Arq Neuropsiquiatr 2008; 66:152-156.
44. Braak H, Bohl JR, Müller CM, Rüb U, de Vos RA, Del Tredici K. Stanley Fahn Lecture 2005: The staging procedure for the inclusion body pathology associated with sporadic Parkinson’s disease reconsidered. Mov Disord 2006; 21:2042-2051.
45. Simpson ER. Genetic mutations resulting in estrogen insufficiency in the male. Mol Cell Endocrinol 1998; 145:55-59.