People with Parkinson’s disease may develop a symptom called hypomimia, which is a loss or reduction of facial expressions. People with this symptom may appear depressed or apathetic, even when that’s not how they’re feeling. As a result, facial masking can lead to misunderstandings and negatively affect social interactions and relationships.

“People always thought I hated them,” one MyParkinsonsTeam member wrote. “After I was diagnosed and found this was a symptom, I looked in the mirror, and it suddenly made sense.”

Various aspects of Parkinson’s contribute to facial masking, but the primary cause is a lack of dopamine in the brain. Recognizing this symptom early on will help you get treatment to address the issue.

What Causes Hypomimia?

Parkinson’s disease is a neurodegenerative movement disorder that affects various functions throughout the body. Neurons (nerve cells) responsible for making dopamine help control facial expressions. Damage to these neurons affects how the muscles of the face move to create an expression in response to brain messages.

In addition, Parkinson’s can cause motor changes that limit the ability to form facial expressions, such as bradykinesia (slowed movements) and muscle rigidity. Stiff facial muscles can impair gestures, such as smiling or raising eyebrows during everyday conversations.

Cognitive impairments from Parkinson’s disease may also make it more difficult to recognize and respond appropriately to other people’s facial or nonverbal cues. People with Parkinson’s may experience changing moods or depression that can be hard to distinguish from the masklike expression caused by reduced dopamine levels. It’s not unusual for this early symptom of Parkinson’s to be misdiagnosed as depression. However, people with Parkinson’s may also feel depressed and require mental health support.

Speech changes, like speaking more softly, can compound the confusion about your true emotions when talking with others. Some of these symptoms can be treated with medication or speech therapy. Educating family members and caregivers about facial masking can increase understanding and patience for better communication despite barriers brought on by the disease.

Impact of Facial Masking

Facial masking can have a negative impact on people’s workplace and social interactions, such as job interviews and day-to-day encounters with others. Studies show that facial masking may negatively affect the well-being of care partners of those with Parkinson’s disease.

Caregivers on MyParkinsonsTeam have shared their challenges reading their loved ones’ expressions: “The hardest thing for me is reading my partner’s facial expression. Does anyone else have this problem?”

Another member commiserated: “OMG! That is the worst thing for me. I haven’t been able to ‘read him’ for a couple of years now.”

Couples therapy can be helpful for people with Parkinson’s and their partners, encouraging them to talk about a range of issues affecting their relationships, whether it’s facial masking or involving adult children in caregiving.

Treating Facial Masking

Talk with your neurologist or another health care provider about how facial masking is affecting you. They can help you understand your options for managing hypomimia. In some cases, general treatments for Parkinson’s disease may help ease your symptoms. Other strategies, like working with a speech-language pathologist or specialized rehabilitation programs, may help improve your facial movements.

Medications

“My first symptom was masking, a stony face, and a flat affect where normal facial expression was missing,” shared a MyParkinsonsTeam member. “I began to have more normal facial expressions as soon as I began meds.”

Levodopa is usually the first medication prescribed for Parkinson’s. This medication replaces depleted dopamine levels and may help with facial masking and other motor symptoms. Levodopa on its own can cause nausea, so it may be combined with a medication called carbidopa to reduce this side effect. Carbidopa helps keep levodopa intact until it reaches the brain.

Other Parkinson’s medications that treat motor symptoms may also help with hypomimia.

Additional Strategies To Manage Hypomimia

A speech-language pathologist with experience in Parkinson’s disease can provide specialized support and resources to help you with facial masking. This may include doing facial movement exercises.

“I move my facial muscles trying to get some expression,” a MyParkinsonsTeam member shared. “My face feels so stiff, and people say I don’t smile like I used to.”

Another member commented, “Some Parkinson’s-related exercise classes include practicing facial expressions to help overcome this symptom. Smiling helps keep facial muscles pliable (a good reason to smile more).”

The Lee Silverman Voice Treatment Loud program (LSVT LOUD) is a form of intensive speech therapy to help people with Parkinson’s increase their speech volume. LSVT LOUD may also help improve your facial movements.

Some small studies have evaluated specialized forms of facial masking therapy. The therapy improved facial expressions in all cases and, in one trial, also improved the participants’ moods.

Talk With Others Who Understand

MyParkinsonsTeam is the social network for people with Parkinson’s disease and their loved ones. On MyParkinsonsTeam, more than 99,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s disease.

Has Parkinson’s affected your or your loved one’s ability to understand nonverbal cues or express emotion? How have these common symptoms of Parkinson’s made an impact on your quality of life and relationships? Share your experience in the comments below, or start a conversation by posting on your Activities page.