Eye blinking characteristics as potential biomarkers in Isolated REM sleep behavior disorder during visuospatial attention tasks

Introduction: Isolated REM sleep behavior disorder (iRBD) is a prodromal stage of alpha-synucleinopathies, such as Parkinson's disease (PD). Although altered eye blinking patterns are recognized as a clinical feature in PD, no studies have investigated its prodromal stage. This study aimed to investigate eye blinking characteristics in iRBD patients during a visuospatial attention task. Methods: A total of 131 iRBD (aged 67.1 years) and 50 healthy controls (HCs; aged 66.2 years) participated. Patients who developed PD (PD-CV) or dementia with Lewy bodies (DLB-CV) were grouped as converters, while the others as non-converters (iRBD-NC). At baseline, during Posner's task, electroencephalogram and electrooculogram signals were recorded, and vertical ocular components were extracted. Blinking events were automatically identified within two temporal windows, where eye blinks were predominantly observed. Blink latency and rate in each window were compared between groups. Results: In the 2nd window (1300 ms–1800 ms), iRBD exhibited delayed blink latency compared to HC (1549 ms vs. 1529 ms, p = 0.021) while blink rate was not different. Blink rate showed correlations with cognitive (r = 0.192, p = 0.028) and motor (r = −0.254, p = 0.009) functions in iRBD patients. PD-CV (n = 18) exhibited a decreasing trend in blink rate compared to iRBD-NC (n = 105; 25.9 % vs. 40.9 %, Bonferroni-corrected p = 0.052). Conclusions: Altered eye blink characteristics potentially serve as markers reflecting pathophysiology of alpha-synucleinopathies. iRBD is linked to delayed blink latency; moreover, a decreased blink rate could serve as a predictor of PD-specific neurodegeneration.