Objective: To assess the prevalence of diplopia in Parkinson’s disease (PD) patients and the correlation of diplopia with visual hallucinations, cognitive dysfunction and motor performance.

Background: Diplopia is integral to nonmotor (NMS) assessment of PD, a part of the NMS questionnaire (NMSQuest) and  the overall spectrum of positive visual symptoms in PD. Although prevalence is usually reported in NMS studies the symptom is frequently overlooked and may have important functional implications on the quality of life (QoL) of patients with PD.

Method: 131 consecutive PD patients attending a MD clinic were included in the study. Diplopia was screened by using the NMSQuest – item 29 and Non-Motor Symptoms Scale for Parkinson’s Disease (NMSS) – item 15. Cognitive function was assessed with Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Visual hallucinations were measured by Scales for Outcomes in Parkinson’s Disease – Psychiatric Complications (SCOPA-PC). QoL was assessed with Parkinson’s Disease Questionnaire-39 (PDQ-39).

Results: 12.2% had self-declared diplopia (n=16), 31.2% male (n=5). The mean age of patients with diplopia was 76.0± 9.0 years. PD patients with diplopia had longer disease duration than those without diplopia (5.6±3.4 years vs 4.9±4.3 years, p=0.53) and worse cognitive dysfunction MMSE scores (25.4± 2.9 vs 27.3 ±3.2, p=0.02) and MoCA scores respectively (20.4 ±5.2 vs 24.0± 5.3, p=0.01). Visual hallucinations were present in 31.2% of PD (n=5) patients with diplopia compared to only 8.6% of PD patients without diplopia. Motor performance determined by the MDS-UPDRS part III score and Hoehn and Yahr stage did not differ significantly between the groups.  PDQ-39 Summary Index was significantly higher in patients with diplopia compared to patients without diplopia (35.3±12.7 vs 22.9±14.1)(p=0.001)

Conclusion: Diplopia can occur in over 10% of an unselected cohort of PD cases with longer disease duration, cognitive dysfunction, worse QoL and may include hallucination related diplopia which has been described (Sauerbier & Chaudhuri, 2013) and needs to be considered in clinical practice.

References: 1. Sauerbier, A., & Ray Chaudhuri, K. (2013). Parkinson’s disease and vision. Basal Ganglia, 3(3), 159–163. doi:10.1016/j.baga.2013.05.002

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diplopia-double-vision-in-parkinsons-disease-patients-prevalence-and-nonmotor-effect/