Objective: To investigate the characterization of diplopia and visual complaints including minor forms of hallucinations (mHals) in non-demented patients with Parkinson disease (PD).

Background: Double vison has been frequently ignored and one of unmet needs in PD patients. It has been reported that 20.0% of PD patients complained diplopia in the international large study using Nonmotor Symptoms Questionnaire (Martinez-Martin P et al, 2007). However, little is known about the clinical manifestation of diplopia related to mHals and motor off-fluctuations (MFs).

Method: A single center cross-sectional survey on outpatients. Patients; clinically probable PD patients diagnosed by MDS clinical diagnostic criteria with cardiac sympathetic denervation on MIBG scintigraphy. Consecutive PD patients without dementia and complex visual hallucinations received a structured interview about visual problems which were focused on the details of binocular diplopia, the existence of mHals, the relationship to MFs and improvement of diplopia after levodopa treatment.

Results: In 60 PD patients (age, 72.5 ± 7.5 years old; PD duration, 6.0 ± 3.1 years; mean ± SD), 45% (n=27) experienced diplopia. Patients with diplopia showed significantly longer disease duration of PD, higher Hoehn & Yahr staging (H&Y) and higher daily levodopa equivalent dose (LED) (PD duration, 6.7 ± 2.9 years; H&Y,2.7 ± 0.7; LED, 585 ± 245 mg) compared to those without diplopia (PD duration, 5.3 ± 3.1 years; H&Y, 2.3 ±0.6; LED, 419 ± 238 mg, p<0.05, respectively). Diplopia was described as a frequent symptom (rare, 15%; frequent, 19%; often, 44%; very often, 22%) with mostly mild severity (mild, 67%; moderate, 33%). Double vison resulted in visual problems was reported as horizontal (74%), vertical (19%) or oblique (4%). The mHals with insight (i.e. feelings of passage, non-formed hallucinations) were reported significantly more often among the patients with diplopia (n=15, 56%) compared to those without diplopia (n=2, 6%; p<0.01). Patients with diplopia had significantly more MFs (n=13, 48%) compared to those without diplopia (n=7, 21%; p<0.05).

Conclusion: We revealed that diplopia was associated with not only minor forms of hallucinations, but off period-symptom related to MFs. Therefore, intermittent phase of diplopia associated with MFs may be potentially responsive to levodopa treatment.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/diplopia-and-visual-complaints-in-non-demented-patients-with-parkinson-disease-a-japanese-single-center-cross-sectional-survey/