Objective: To assess the frequency of diplopia and its relation to motor and non-motor symptoms in a cross sectional sample of non-demented patients with idiopathic Parkinson’s disease (PD).

Background: Although diplopia and other perceptional deficits are frequent symptoms in PD so far little is known about the clinical manifestation, causes and treatment of diplopia in PD.

Methods: Non-demented PD patients were screened for the frequency of diplopia in an outpatient unit specialized in movement disorders. Motor and non-motor symptoms were rated with the MDS-UPDRS and the NMSQuest. Frequency and manifestation of each non-motor symptom was rated according to the NMSScale (Storch et al, 2010). Deficits in spacial perception and ophthalmological comorbidities were assessed by interview.

Results: In our cohort of 82 non-demented PD patients 30.5% (n=25) had diplopia with a mean symptom duration of 5.2 (±10.3) months. Most patients had selective diplopia and reported frequent occurence and moderate manifestation. PD patients with and without diplopia did not differ regarding age, sex, education or ophthalmological comorbidities. PD patients with diplopia had significantly longer disease duration (11.5±7.8 years vs 7.8±7.1, p=.027) and more motor fluctuation (MDS-UPDRS part IV) (5.2±5.4 vs 1.7±3.1, p=.019) compared to PD patients without diplopia. 60% of the patients with diplopia had concurrent visual hallucinations compared to 15.8% without diplopia (p<.001) and 21% had coincident deficits in spatial perception compared to 1.8% in PD patients without diplopia (p=.003). PD patients with diplopia reported significantly more often about memory problems (p=.012), loss of interest in surroundings (p=.001), hallucinations (p<.001) and delusions (p=.032). However, motor performance based on the MDS-UPDRS part III (38.8±15.6 vs 32.5±10, p=.142) and Hoehn and Yahr stage (p=.063) did not differ between the groups.

Conclusions: Diplopia represents a frequent deficit in non-demented PD patients independent of motor symptoms. However, diplopia was associated with the presence of visual hallucinations, deficits in spacial perception, memory problems and delusions. PD with diplopia might represent a subtype with predominantly perceptional deficits and cognitive dysfunction. Reference: Storch A et al. (2010) Non-Motor Symptoms Questionnaire and Scale for Parkinson’s disease. Cross-cultural adaptation into the German language. Nervenarzt.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/frequency-and-characteristics-of-diplopia-in-non-demented-patients-with-parkinsons-disease/