This study presents an automated, objective method for eyelid movement assessment in de-novo Parkinson's disease(PD) using a one-dimensional camera setup during monologue. These measurements were related to Dopamine Transporter Single Photon Emission Tomography and clinical scores. State-of-the-art computer-vision technologies and deep-learning neural networks were utilized to measure fourteen eyelid movement markers describing blinking and eyelid kinematics. Video-recordings were collected from a total of 120 de-novo patients with PD and 55 healthy controls. Abnormal blinking was present in 38% of PD, indicated by a reduced blink rate (p < 0.001), an increased inter-blink interval (p < 0.001), and an increased rigidity of the palpebral aperture (p < 0.001). The classification experiment reached an area under the curve of 0.81 on a blinded test set. The blink rate correlated with the loss of nigral dopaminergic neurons (r = 0.35, p < 0.001). These findings suggest eyelid movement markers as strong reflections of striatal dopaminergic activity levels, underscoring the method's potential as a reliable early PD biomarker.

Department of Circuit Theory Faculty of Electrical Engineering Czech Technical University Prague Prague Czech Republic

Department of Neurology and Centre of Clinical Neuroscience 1st Faculty of Medicine Charles University Prague Czech Republic

Institute of Nuclear Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

See more in PubMed

Bologna, M., Paparella, G., Valls-Solé, J., Hallett, M. & Berardelli, A. Neural control of blinking. Clin. Neurophysiol.161, 59–68 (2024). PubMed

Kaneko, K. & Sakamoto, K. Spontaneous blinks of Parkinson’s disease patients evaluated by EMG and EOG. Electromyogr. Clin. Neurophysiol.41, 87–96 (2001). PubMed

Korošec, M., Zidar, I., Reits, D., Evinger, C. & VanderWerf, F. Eyelid movements during blinking in patients with Parkinson’s disease. Mov. Disord.21, 1248–1251 (2006). PubMed

Agostino, R. et al. Voluntary, spontaneous, and reflex blinking in Parkinson’s disease. Mov. Disord.23, 669–675 (2008). PubMed

Bologna, M. et al. Facial bradykinesia. J. Neurol. Neurosurg. Psychiatry84, 681–685 (2013). PubMed

Karson, C. N. Spontaneos Eye-Blink Rates and Dopaminergic Systems. Brain106, 643–653 (1983). PubMed

Bologna, M., Fasano, A., Modugno, N., Fabbrini, G. & Berardelli, A. Effects of subthalamic nucleus deep brain stimulation and l-dopa on blinking in Parkinson’s disease. Exp. Neurol.235, 265–272 (2012). PubMed

Fitzpatrick, E., Hohl, N., Silburn, P., O’Gorman, C. & Broadley, S. A. Case–control study of blink rate in Parkinson’s disease under different conditions. J. Neurol.259, 739–744 (2012). PubMed

Rajnoha, M. et al. Towards Identification of Hypomimia in Parkinson’s Disease Based on Face Recognition Methods. 2018 10th International Congress on Ultra Modern Telecommunications and Control Systems and Workshops (ICUMT) 1–4, 10.1109/ICUMT.2018.8631249 (IEEE, Moscow, Russia, 2018).

Abrami, A. et al. Automated Computer Vision Assessment of Hypomimia in Parkinson Disease: Proof-of-Principle Pilot Study. J. Med. Internet Res.23, e21037 (2021). PubMed PMC

Novotny, M. et al. Automated video-based assessment of facial bradykinesia in de-novo Parkinson’s disease. npj Digit. Med.5, 1–8 (2022). PubMed PMC

Peshori, K. R., Schicatano, E. J., Gopalaswamy, R., Sahay, E. & Evinger, C. Aging of the trigeminal blink system. Exp. Brain Res.136, 351–363 (2001). PubMed

Karson, C. N., Lewitt, P. A., Calne, D. B. & Wyatt, R. J. Blink rates in parkinsonism. Ann. Neurol.12, 580–583 (1982). PubMed

Deuschl, G. & Goddemeier, C. Spontaneous and reflex activity of facial muscles in dystonia, Parkinson’s disease, and in normal subjects. J. Neurol. Neurosurg. Psychiatry64, 320–324 (1998). PubMed PMC

Kimber, T. E. & Thompson, P. D. Increased blink rate in advanced Parkinson’s disease: A form of ‘off’-period dystonia?. Mov. Disord.15, 982–985 (2000). PubMed

Maycas-Cepeda, T. et al. Hypomimia in Parkinson’s Disease: What Is It Telling Us?. Front. Neurol.11, 603582 (2021). PubMed PMC

Jankovic, J. Parkinson’s disease: clinical features and diagnosis. J. Neurol. Neurosurg. Psychiatry79, 368–376 (2008). PubMed

Bologna, M. et al. Neuroimaging correlates of blinking abnormalities in patients with progressive supranuclear palsy. Mov. Disord.31, 138–143 (2016). PubMed

Pirker, W. et al. Progression of dopaminergic degeneration in Parkinson’s disease and atypical parkinsonism: A longitudinal β-CIT SPECT study. Mov. Disord.17, 45–53 (2002). PubMed

Kägi, G., Bhatia, K. P. & Tolosa, E. The role of DAT-SPECT in movement disorders. J. Neurol. Neurosurg. Psychiatry81, 5–12 (2010). PubMed

Matesan, M. et al. I-123 DaTscan SPECT Brain Imaging in Parkinsonian Syndromes: Utility of the Putamen-to-Caudate Ratio. J. Neuroimaging28, 629–634 (2018). PubMed

Özekmekçi, S., Benbir, G., Özdogan, F. Y., Ertan, S. & Kiziltan, M. E. Hemihypomimia, a rare persistent sign in Parkinson’s disease. J. Neurol.254, 347–350 (2007). PubMed

Guerra-Hiraldo, J. D. et al. Hemihypomimia in Parkinson’s disease: an under-recognized clinical sign?. J. Neurol.270, 548–551 (2023). PubMed

Kartynnik, Y., Ablavatski, A., Grishchenko, I. & Grundmann, M. Real-time Facial Surface Geometry from Monocular Video on Mobile GPUs. arXiv preprint, 10.48550/arXiv.1907.06724 (2019).

Bologna, M. et al. Blinking in patients with clinically probable multiple system atrophy. Mov. Disord.29, 415–420 (2014). PubMed

Fekete, R. & Jankovic, J. Upper facial chorea in Huntington disease. J. Clin. Mov. Disord.1, 7 (2014). PubMed PMC

Dušek, P. et al. Clinical characteristics of newly diagnosed Parkinson’s disease patients included in the longitudinal BIO-PD study. Cesk. Slov. Neurol. Neurochir.83, 633–639 (2020).

Postuma, R. B. et al. MDS clinical diagnostic criteria for Parkinson’s disease: MDS-PD Clinical Diagnostic Criteria. Mov. Disord.30, 1591–1601 (2015). PubMed

Berg, D. et al. Movement disorder society criteria for clinically established early Parkinson’s disease. Mov. Disord.33, 1643–1646 (2018). PubMed

Goetz, C. G. et al. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results. Mov. Disord.23, 2129–2170 (2008). PubMed

Kopecek, M. et al. Montreal cognitive assessment (MoCA): Normative data for old and very old Czech adults. Appl. Neuropsychology: Adult24, 23–29 (2017). PubMed

Darcourt, J. et al. EANM procedure guidelines for brain neurotransmission SPECT using 123 I-labelled dopamine transporter ligands, version 2. Eur. J. Nucl. Med. Mol. Imaging37, 443–450 (2010). PubMed

Dušek, P. et al. Relations of non-motor symptoms and dopamine transporter binding in REM sleep behavior disorder. Sci. Rep.9, 15463 (2019). PubMed PMC

Google. Face landmark detection guide for Python | Google AI Edge https://ai.google.dev/edge/mediapipe/solutions/vision/face_landmarker/python. (2024)