P32. Prevalence of parkinson symptoms among patients with peripheral vestibular disorders

Abstract

Introduction In a recent epidemiologic study 5.3% of patients with parkinson disease (PD; mean age 70.5years) and up to 11% of PD patients with self-reported vertigo and dizziness had a benign paroxysmal positional vertigo (BPPV) (VanWensen et al., 2013). The prevalence of PD in industrialized countries is generally estimated at 0.1– 0.3% of the entire population (mean age German population ∼44years). It is more common in the elderly, where prevalences rise from 1.8% in those over 65years of age to 2–3% in the population over 80years (Official guidelines of the German Neurological Society, 2012; De Lau and Breteler, 2006). Thus, two questions arise: first, whether the prevalence of PD is increased in patients with diagnosed BPPV, and secondly, whether the prevalence of parkinson symptoms differs in patients with BPPV compared to those with other peripheral vestibular syndromes such as an unilateral peripheral vestibular loss (vestibular neuritis, VN) or Meniere‘s disease (MD). Methods All patients with diagnosed BPPV ( n =2347), MD ( n =1481) and VN ( n =713) seen in an interdisciplinary dizziness unit as well as in the German Center for Vertigo and Balance disorders of the Munich University between 2004 and 2013 were retrospectively analysed concerning their signs and symptoms of PD. All patients routinely underwent a detailed neurological examination and detailed vestibular testing. The parkinson symptoms were retrospectively classified according to the modified Hoehn and Jahr scale (Goetz, 2004). Results The prevalence for parkinson symptoms in the total BPPV group (mean age 59years) was 1.1%. In the subgroups of BPPV patients >65years of age it raised to 2.6% ( n =25), >70years to 3.5% ( n =23; mean age 77years), and >80years to 4.5% ( n =8). The parkinson symptoms were only mild (Hoehn and Jahr stages ⩽ 2 in the great majority of patients; only 4 patients at stage 3). In VN (mean age 55years) and MD (mean age 59years) the prevalences lay within the range of the normal population: 0.1% in all VN patients, respectively 0.5% in those >65years ( n =1); 0.3% in MD patients, respectively 0.7% in those >65years ( n =4). Conclusions Among patients with peripheral vestibular disorders only the BPPV patients showed a slightly increased prevalence of parkinson symptoms compared to the general population (2.6% vs. 1.8% in patients >65years). However, the prevalence for PD in BPPV patients (3.5% >70years, mean age 77years) seems to be lower than the prevalence for BPPV in PD (5.3% at a mean age of 70.5years) at least in less severely affected patients that can visit an outpatient clinic.