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Micrographia (Handwriting Difficulties) and Parkinson’s Disease

Updated on May 17, 2022
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Sarah Winfrey

Many symptoms of Parkinson’s disease and parkinsonism can interfere with daily life. Parkinson’s disease symptoms fall under two general categories: motor and nonmotor. One of the less common motor symptoms is micrographia. Micrographia causes small, cramped handwriting and often worsens as the person continues to write in a single sitting.

Here’s what you need to know about micrographia, including why it occurs in Parkinson’s and how to manage this symptom in day-to-day life.

What Is Micrographia?

The prefix “micro-” means “small,” and the suffix “-graphia” refers to writing. “Micrographia,” then, refers to small handwriting. A person with micrographia makes unusually small letters and writes words very close together. This handwriting usually looks cramped and is hard to read. Some people with micrographia find that their handwriting gets smaller and smaller the longer they write without a break.

Micrographia is often one of the first symptoms of Parkinson’s. A study of 68 men with Parkinson’s found that almost half experienced micrographia. Micrographia appears to be closely correlated with both hypophonia (soft, quiet speech) and bradykinesia (slowed movement), two common symptoms of Parkinson’s.

How Does Micrographia Affect Daily Life?

Many MyParkinsonsTeam members have shared what it’s like living with micrographia. One member wrote, “My handwriting is illegible even to me.” Another explained, “My handwriting is terrible, too, and it was my first indicator of Parkinson’s. That was 11 years ago, and now my writing is totally illegible.”

Micrographia can take many forms. Some people feel that it comes up randomly. “I'm a teacher and have difficulty writing/printing things on the board freehand,” one member wrote. “I start off with each letter a good size, but as the sentence progresses, the size of each letter becomes more random. Some are the same size as when I started, then get smaller, then the next one will be back at normal size. And the sentence itself is hardly ever straight.”

This member shared that micrographia makes it hard to keep their job because writing is such an integral part of teaching.

Another member described their challenge to find volunteer work: “My handwriting has become unreadable, and I can't come up with any volunteer job where I don't have to write.”

Impaired handwriting can interfere with daily tasks in several ways. One member, for instance, has trouble writing checks: “Too many checks were being rejected by the bank because of illegibility. Now I have someone else write the checks and make sure I sign them correctly.”

Micrographia can make tasks such as paying bills and filling out forms more difficult. As the Parkinson’s Foundation notes, micrographia can cause a person’s signature to change over time. Significant differences may affect certain legally binding documents.

Fortunately, you can take steps to improve your handwriting. First, though, it’s important to understand why Parkinson’s causes micrographia.

What Causes Micrographia in Parkinson’s?

Micrographia results from the same changes in the brain that cause other Parkinson’s symptoms. Parkinson’s is a neurodegenerative disorder characterized by low dopamine levels. When levels dip so much that neurons no longer function normally, a person’s movement is usually affected, and symptoms such as micrographia occur.

Other motor symptoms can also make it harder to write. If your body moves slower than it used to, you experience tremors or shaking, or your movement is rigid, your handwriting may be affected. Symptoms that involve motor control and fine motor skills will also likely have an impact on your handwriting. All these movement difficulties seem to stem from changes that occur in the brain’s basal ganglia and are characteristic of Parkinson’s.

Managing Micrographia With Parkinson’s

Although there is not yet a cure for Parkinson’s, several strategies can help improve your handwriting and combat micrographia. Talk with your doctor, your neurologist, or another health care provider to help determine the best options for you.

Try Handwriting Therapy

Handwriting therapy for people diagnosed with Parkinson’s usually involves some sort of writing practice, depending on which option you and your doctor choose.

Neuroscientists report that handwriting therapies can improve legibility, though people may not be able to write faster. These therapies may also improve overall neuron connectivity and function in the brain, leading to benefits in other motor functions. Many people with Parkinson’s are able to retain their writing skills longer after handwriting therapy.

Some MyParkinsonsTeam members have had great success with these interventions. As one shared, “I received a DVD on therapy from my movement disorder specialist that had recommendations for handwriting practice. I have made practicing my handwriting part of my exercise, stretching, and therapy. I even brought out some old calligraphy pens from a college class to help change things up. I have seen an improvement with my writing.”

Change Your Writing Habits

Some personal penmanship habits may be making it harder for you to write. Changing your habits may feel like relearning how to write, but practicing a few techniques can improve legibility.

Consider following writing habits such as these:

  • Choose a fatter pen or use a grip that slides onto the end of your pen.
  • Write on lined paper so you have visual cues for the target size of your letters.
  • Try printing if you usually write in cursive.
  • Focus on each letter as you form it — doing so often means slowing your writing.
  • Use a ballpoint pen for a smoother flow.
  • Don’t write too much at once. Rest between lines or short paragraphs.
  • Write regularly and intentionally. Deciding not to pick up a pen again may not be the answer.

One member found tips like these very helpful. “I now use printed rather than cursive script. I find I have much better control,” they said. “Also, I use a ballpoint pen with a large nib rather than a fine one. Felt ink pens that are midrange also work very well but can be a bit heavy for certain things.”

Implement Technological Solutions

If your handwriting is not improving or you need a quick solution to jump-start practicing, technology can help. Some of our members love their technological solutions. One explained, “I have a tablet where I type out what I need, my poems, and my stories. Then it prints out my lists, letters, stories, emails, etc., so they are legible for others to read.”

Treat Your Parkinson’s

Most people diagnosed with Parkinson’s will take medication for the condition. Many options, such as levodopa/carbidopa, boost dopamine levels in the brain (called dopaminergic medications). Taking these medications may improve many Parkinson's symptoms, including micrographia.

One member reported that medications led to better handwriting: “I have found that if my meds are working and I don’t get anxious and I take my time, my handwriting can look pretty good.”

Medication may not be the only answer for micrographia associated with Parkinson’s, but it often contributes to the solution.

Talk With Others Who Understand

MyParkinsonsTeam is the social network for people with Parkinson’s disease and their loved ones. More than 87,000 members come together to ask questions, give advice, and share their experiences with others who understand life with Parkinson’s.

Have you noticed changes in your handwriting since your diagnosis? What have you done to improve your writing? Let others know in the comments below or by posting on MyParkinsonsTeam.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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