If You Can’t Show Emotion It May Be An Early Sign Of Parkinson’s
One of the early signs of Parkinson’s is hypomimia, colloquially referred to as a “masked face” or “facial masking.” Parkinson’s causes muscles to stiffen and slow down, which can include the muscles in your face, causing you to appear emotionless.
David Beatty MRCGP, MBBS, a U.K.-based general practitioner, says that, for those with Parkinson’s, “facial muscles move less resulting in fewer smiles or grimaces.” Additionally, Beatty says, “the eyes don’t blink so much and there is less movement of the muscles around the eyes and the forehead.”
Tips For Living With Masked Face
If you have Parkinsons, masked face can be a barrier between you and those you care about most. It may also impact the relationships you have with caregivers, including your doctors.
Masked face may also be frustrating for caregivers at times, who find it hard to understand what their loved one is feeling or thinking.
Here are a few tips for living with masked face:
- If you or your loved one has masked face, discuss it with a doctor. In many instances, a change of medication or dosage may help to alleviate or reduce this symptom.
- Keep active for as long as possible by participating in physical and creative activities.
- If youre a caregiver to someone who has this symptom, be aware that apathy and depression may or may not accompany it. Work on communicating by asking questions without assuming the answers. Are you OK? probably wont be as effective as Are you sad? or Are you enjoying this outing?
- Try to be empathetic and to use empathetic phrasing whenever possible. Let the person know you understand their frustration and what theyre feeling.
- If youre a caregiver to a loved one with a chronic condition, its vital that you take care of yourself as well as them. Find someone who can shoulder the day-to-day with you. Also, make sure to carve out time for self-care.
Does Parkinsons Affect Voice
The voice is affected too, because the voice box is ultimately controlled by the basal ganglia as well. Thus the voice becomes soft, slurred and hushed. Others may comment that the patient is mumbling. The mumbling goes away temporarily once the patient becomes aware of it but soon returns to the soft, slurred state.
This temporary improvement when attention is paid is true of many of the motor symptoms of PD because the condition primarily affects subconscious movements, and does not directly affect nerve or muscle control at the most basic level. Thus, conscious awareness can override the slowness to a certain extent. This fact is one reason why physical therapy and physical activity are so useful and necessary in treating PD.
- Slowness of walking and other movements
- Trouble with dexterity
Imbalance, loss of balance reflexes
- May fall backwards
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How Does Parkinsons Affect The Face
Everyday tasks such as getting dressed, writing, picking something up off the floor take twice as long as they used to. Some people describe the feeling of slowness and stiffness as walking through molasses or moving in slow-motion. Because subconscious muscle movements of the face are responsible for ones facial expressions and others interpretation of our mood, patients can be thought to be upset or depressed when they are not. This is known as having a masked face.
Parkinsons Surgery: Pallidotomy And Thalamotomy
Another type of surgery used when symptoms are poorly responsive to medications is brain surgery that either removes or destroys brain tissue. The techniques are termed pallidotomy and subthalamotomy. The techniques usually involve radiofrequency to destroy small areas of brain tissue. Some patients symptoms can be reduced by these techniques but they do not reduce all symptoms and some patients suffer complications when brain tissue is irreversibly destroyed. Deep brain stimulation is replacing these treatments.
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Facial Masking And Medication
Some medications have been found to improve symptoms of a masked face with Parkinson’s disease. They include levodopa , a drug often used to replace dopamine. Researchers have demonstrated a link between facial masking symptoms and low dopamine responses.
Because levodopa alone leads to side effects of nausea and vomiting, it’s usually given as a combined drug with carbidopa, such as Sinemet or Parcopa.
For some people, a surgically implanted device in the abdomen will deliver Duopa, a carbidopa-levodopa combination that is continually administered and reduces what’s known as “off time,” when drug benefits are reduced.
Other medications used to treat facial masking include:
- Stalevo, adding entacapone to the carbidopa-levodopa mix
- Mirapex , a dopamine agonist
- Requip , also an agonist
- Neupro patches and APOKYN injections
Other drugs, such as catechol-o-methyl transferase inhibitors and monoamine oxidase type B inhibitors, may be used to boost the effects of levodopa.
Join The Parkinsons Forums: An Online Community For People With Parkinsons Disease And Their Caregivers
Does your loved one seem to be dragging one of their feet when they walk? Are they shuffling slightly? Has one of their arms lost its swing when they walk? Do they seem stiff in their movements? You have an objective perspective and may notice these things sooner.
No one who is happy or joyful likes to be asked, Whats wrong with you? That can happen with an early sign of PD known as the masked face. Why masked face? Because the facial muscles have tightened and people with PD have a harder time smiling or showing emotion.
Another symptom that I struggle with is my voice getting softer, making it hard for others to hear me. I had a soft voice to begin with, and when it got softer it made it more difficult to converse. Speech and vocal exercises can be done to strengthen the vocal cords if the problem is due to PD.
If you think someone you know might have early signs of PD, you might want to approach them as if they hadnt noticed their symptoms. For example, dont stare at them when they are shaking and ask, Do I make you nervous? Ask them if theyve noticed that their hand shakes slightly. If they bring it to your attention, encourage them to have it checked out. If they are concerned and you act like its nothing, especially when you notice it, coupled with other signs related to early PD, they will feel silly and may think they are imagining things.
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Check Out The Second Podcast
Dr. Tickle-Degnen had a lot of interesting information to share, so part two of my interview focuses on her current research along with ideas and tactics for people who experience facial masking.
- Tickle-Degnen, L., Zebrowitz, L.A., Ma, H. . Culture, gender, and healthcare stigma: practitioners response to facial masking experienced by people with Parkinsons disease. Social Science and Medicine, 73: 95-102.
Kelsey Phinneys dad, Davis Phinney, was diagnosed with Parkinsons when she was five years old and she has been interested in learning more about the brain and ways to help people living with Parkinsons ever since. Kelsey graduated from Middlebury College in May of 2016 with a degree in neuroscience and is currently cross country skiing professionally in Sun Valley, Idaho. Learn more about Kelsey at www.kelseyphinney.com.
But A Masked Facial Expression Doesn’t Necessarily Mean The Person Is Depressed
It may seem like the obvious conclusion is that someone with a blank facial expression is upset. However, experts have said that a masked face in Parkinson’s patients is not necessarily linked to emotion. Beatty says that it’s generally caused by the disease, not depression, but he also notes that the two conditions can co-exist.
The study in the European Journal of Neurology found that while people with a masked face did have less apathy, they did not have increased depression or anxiety. Meanwhile, the Parkinson’s Foundation estimates that at least half of people with Parkinson’s will experience a form of depression during their illness, and up to 40 percent will develop an anxiety disorder.
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Therapy For Masked Facies
Facial expression matters. Research has shown that quality of life is better in persons with Parkinsons who have undergone therapy to improve facial control than those who have not. It typically demands an intensive, therapist-guided program which would initially focus on broader facial movements, such as lifting the eyebrows, stretching the mouth, or puckering the face.
One technique called the Lee Silverman voice treatment is used by some to help people with Parkinsons speak louder and clearer. It employs articulation exercises that are similar to stage acting techniques in which a person is taught to projects and enact speaking behavior by:
- Looking a person directly in the face
- Keeping the chin up
Living With Parkinsons Disease
Parkinsons disease, especially in the more advanced patients, often requires an adjustment in lifestyle. As symptoms progress, anxiety and depression are often experienced by the patient . Items in the home such as throw rugs, electrical cords, and slippery tile may need to be removed to reduce the risk of falls. Bathroom modifications such as handles or grab bars may be needed. The diet might need modification if swallowing or constipation becomes a problem. An occupational and speech therapist may help with other problems.
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How Does Pd Affect Facial Appearance
PD is a chronic, progressive disease of the nervous system. The most common PD symptoms include:2
- Tremors or shaking at rest
- Rigidity of the limbs and trunk
- Difficulty balancing
- Slowness of movement
However, PD might also cause a slew of emotional and communication problems, severely affecting social interaction. One of these problems is a mask-like expression, also known as hypomimia. This can include:2
- Issues producing animated or emotional facial expressions
- Trouble producing emotional speech
- Problems recognizing the emotional, verbal, and nonverbal cues of others
A mask-like facial expression is when the person’s eyebrows, lower lip, and face do not move. This happens because the person has lost the ability to properly control the movement of these muscles. With facial masking, you can appear like you are staring, not interested, angry or upset, or disengaged.1
When you are trying to express yourself one way and your face is telling a different story, this frustration can easily lead to anger and isolation.1,3,4
Therapy For Facial Masking
Facial expression matters. Research has shown that quality of life is better in persons with Parkinson’s who have undergone therapy to improve facial control than those who have not.
Therapy typically demands an intensive, therapist-guided program which would initially focus on broader facial movements, such as lifting the eyebrows, stretching the mouth, or puckering the face.
One technique called the Lee Silverman voice treatment is used by some to help people with Parkinson’s speak louder and more clearly. It employs articulation exercises that are similar to stage acting techniques, in which a person is taught to project and enact “speaking behavior” by:
- Taking deep breaths before speaking
- Focusing on big, loud sounds and slow, short phrases
The LSVT technique and similar rehabilitative approaches have proven valuable in helping people living with Parkinson’s to isolate and control specific facial muscles more effectively when communicating in groups or one-on-one.
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Challenges Of The Mask
Interaction with others is a mixture of verbal and nonverbal communication, and facial expressions play a large role in the nonverbal communication, displaying our emotions and interest. When PD affects the facial muscles, causing a mask-like expression, many of the nonverbal cues are not present, which may lead to challenges communicating with others and negatively impact relationships. The relationships most often affected are those with family and friends, as well as relationships with healthcare providers. The emotion behind the words may be further compromised by a monotone voice, another symptom that makes it difficult for a person with PD to vary the tone of their voice.3,4
Research into the facial masking that occurs with PD has found that people with PD have less facial masking when responding to positive questions and more facial masking is seen when patients respond to negative questions. Unfortunately, most healthcare appointments focus on problems, which may lead to more missed cues in relationships between people with PD and their healthcare providers.4
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Tool To Identify Parkinsons Disease Using Digital Facial Expression Biomarkers
Study Rationale:Traditional Parkinsons disease detection and monitoring systems lack objective biomarkers and are often reliant on late-stage symptoms. By contrast, a masked face is often seen in early-stage PD and even years before diagnosis. In this study, we aim to validate the reliability of a tool that objectively captures and identifies the masked face and other early-stage facial expression impairments and micromovements.
Hypothesis:We hypothesize that in PD, facial expressions may communicate disease state and provide an external manifestation of early, pre-nigral PD pathology. If this is true, spontaneous and posed facial expression impairments in PD may be objectively identified and used to detect early stages of PD and may differentiate between commonly misidentified disorders.
Study Design:In this study, we will objectively measure and digitize the masked face associated with early stages of PD. Study participants will undergo a process to elicit and collect certain spontaneous and posed facial expressions. We will then determine if facial expression impairments are able to detect PD and differentiate between atypical parkinsonism disorders. We also hope to determine whether facial expression impairments can predict the severity and progression of PD.
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The Aim Was To Give The Normal Person I Was Photographing The Small Feeling Of What The Loss Of Control Was Like Even For A Couple Of Seconds And For Me To Capture It
How did you get the idea to capture Parkinsons in this way?
Parkinsons makes us stare and show less emotion on our faces than we would normally. None of the subjects had Parkinsons. The aim was to give the normal person I was photographing the small feeling of what the loss of control was like, even for a couple of seconds, and for me to capture it.
Longing
What is the effect gained by using the water technique?
The water acts as a distraction. Try opening your eyes with a face full of water and express an emotion like happiness, for example it is very hard. Without the distraction of the water they would have greater control of their faces and I wanted to take that away. With Parkinsons we sometimes show what we are feeling and at other times we give our faces no clues at all.
What did your subjects think after seeing the photos of themselves?
They were amazed at what they looked like. The most common answer was that they never thought trying to express a specific emotion with a face full of water would be so hard.
Would you say the photography has been a way of coping with Parkinsons?
Yes, totally, all other artistic avenues that I found joy in are a struggle now. Light and dark are my colours and the camera is my brush. I still can create.
Despair
What have you got planned for the future?
What is the treatment and care of Parkinsons like in Australia?
How important is it to have an international community for Parkinsons?
You can get in touch with Chris via
Learn The Symptoms And Treatments For Facial Masking
Facial masking, also called masked facies or hypomimia, is the loss of facial expression most commonly associated with Parkinson’s disease. The condition gives the affected person a fixed, mask-like expression.
There may be several causes of facial masking, including a psychiatric disorder like schizophrenia that may limit affect and expression, or medication that may lead to a similar response. With Parkinson’s disease, the facial masking is typically caused by a progressive loss of motor control.
This article explains why Parkinson’s disease may lead to facial masking and how it is treated. It will help you to learn more about symptoms that sometimes make it harder to interact with loved ones with the condition.
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How To Improve The Loss Of Facial Expression
Facial expression matters. Research has shown that quality of life is better in people with Parkinsons who have undergone regular facial exercise and therapy to improve facial control than those who have not.It is not a secret that people with Parkinsons usually develop reduced facial tone and movements of facial expressions. While not everyone will experience masking with their Parkinsons, those who do may realise that they are blinking often and their stares are blank. Weakness in facial muscles may also cause motor problems like difficulty in swallowing and drooling of saliva.
There are facial exercises which, when practiced regularly, can help better control these symptoms. Its best to perform these facial exercises in front of a mirror. Because a person with Parkinsons cant always accurately feel how big or exaggerate a movement they are making, using a mirror helps them to see the movement for themselves.
These simple exercises include:
1. Smiling
2. The closing of eyes
3. Raising of eyebrows
The occipitofrontalis muscle is a muscle which covers parts of the skull. It consists of two parts or bellies: The occipital belly, near the occipital bone, and the frontal belly, near the frontal bone. The occipitofrontalis muscle is innervated by the facial nerve.
Raise your eyebrows and make creases on your forehead to perform this exercise.It works on your Occipitofrontalis Muscles to promote good blood supply from several arteries.Repeat at least 10 times.