Masked Face Parkinson’s Disease

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.

Masked Faces In Parkinson Disease: Mechanism And Treatment

Inclusion Criteria: – A clinical diagnosis of idiopathic Parkinson disease – Hoeh-Yahr Stage 1-3 when off medication – Stable and optimal medical regimen for at least 3 months – No previous surgical interventions for Parkinson’s disease – Participants will include men and women between the ages of 45 and 80 years Exclusion Criteria: – Evidence of dementia based on neurocognitive testing – Current or past history of major psychiatric disturbance . Participants who are taking anti-depressants will not be excluded as long as they are not currently depressed – Other neurologic disturbance or severe chronic medical illness – Presence of oro-facial dyskinesias – Previous surgeries to the larynx that result in poor vocal fold closure and/or positive history of head and neck cancer – History of smoking in the past 5 years – Untreated hypertension – Failing a baseline test of pulmonary function during baseline respiratory evaluation – Known respiratory complications such as chronic obstructive pulmonary disease , asthma – Previous surgical interventions for Parkinson’s disease

Listen To Kelseys Podcast

I wanted to know more about the implications of facial masking and the importance of facial expressions in social interactions, so that we can all better understand how to respond. I interviewed Professor Linda Tickle-Degnen, Director of the Health Quality of Life Lab at Tufts University. Listen to my podcast to hear about her research on the effects of facial masking, what it is and how it impacts how people are perceived by healthcare professionals as well as their own care partners.

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Face Masks And Unfinished Tasks

The clouds hover overhead this afternoon. It echoes my emotional state of mind as of late.

I wake up to sunshine and clear blue skies. By noon there is a scattered mantle of white. By dinner time the sunshine toys with me. There will be no oohing and aahing over a breathtaking sunset tonight.

I have been fighting apathy. I start projects that I strive to finish but lose my motivation and inspiration. I never used to be like that. I could have several projects going and would work on each one a little at a time. And I could leave a project and pick it up later in the day or in the week and remember what step I was on. Getting back to projects nowadays? I dont care if I do.

Or do I?

Yes! I do care. However, I am sluggish. I often dont have the energy to start or finish a task I would like to accomplish. And nowadays, due to our friend Corona, its not difficult for me to feel friendless.

I had a phenomenal idea last night while feeling alone and somewhat depressed: I could call a friend. If it hadnt been so late, I would have.

I have been doing well, stranded sheltering here at home. But, I admit it is starting to get to me. I miss hugs and smiles. This coronavirus has stolen smiles from all over the world. You cant see people smile under a mask. Its kind of like having Parkinsons disease a permanent masked face.

The other day I was checking out at the grocery store and the clerk said, Could you back up a few feet?

How Facial Masking Influences Perception And Relationships

Earlier this fall, my parents came to visit me in Sun Valley, Idaho. During their visit, we had some of my new friends over for dinner. These friends had never met my parents, and they also had never met a person living with Parkinsons.

Thanks to my recent work with the Davis Phinney Foundation, Ive come to understand that it is important to be able to talk about the different sides of Parkinsons with those close to you. With this in mind, I realized that the main thing I needed to tell my friends before dinner was that one of the more notable symptoms of my dads Parkinsons is facial masking.

My dad has an amazing smile, makes goofy faces and gets that sparkle in his eye when he talks about something hes passionate about. While those things havent disappeared with years of Parkinsons, they unfortunately can be subdued. Particularly when he is tired, his face can appear to be masked.

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Why Does Pd Cause A Mask

Dopamine is a chemical messenger in the brain. Dopamine sends messages to parts of the brain that control smooth, purposeful movement.1,5

In PD, areas of the brain that are heavily damaged also have reduced dopamine activity. As a result of decreased dopamine messages to certain parts of the brain, muscles of the face become stiff and hard to move, making it hard to smile or have other expressions we are normally used to seeing on a person’s face.1,5

What Is A Parkinsons Mask

We caught up with Parkinsons nurse Linda, from the Parkinsons UK helpline, to find out more about a Parkinsons mask.

In people with Parkinsons, a lack of dopamine in the brain can stop your facial muscles working as well as they used to.

• When this happens, people with the condition can look like they have a blank expression, even if they are actually experiencing a strong emotion. The medical term is hypomimia.
• Having a Parkinsons mask is a common symptom. But this doesnt mean someone with the condition is feeling low or depressed they just cant use their facial muscles to express themselves as easily anymore.
• However, many people with Parkinsons also report issues like apathy and problems with motivation, meaning they may not respond to emotions like they used to.
• It may seem like there is a link in some cases, but it may be two common aspects of Parkinsons, happening at the same time.

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Nowadays I Always Wear 2 Masks

I received an email yesterday from my mother-in-law. It had been forwarded to her from a friend of hers. It was missing the attachment, so I dont know what the email said apart from the five words found in the subject line. They read: Why I wear two masks.

It intrigued me and made me think about those of us with Parkinsons disease who already wear two masks every day.

Automated Computer Vision Assessment Of Hypomimia In Parkinson Disease: Proof

1IBM Research Computational Biology Center, Yorktown Heights, NY, United States

2Parkinsons and Movement Disorders Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

3Department of Neurology, Tufts Medical Center, Boston, MA, United States

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The Masked Face Symptom

As per a report by The Science Times, this new sign of Parkinsons makes the face of a patient expressionless. The patient can reportedly be identified if he has unconsiderable facial expressions like frowning or smiling and may even appear depressed or angry. As per James Beck, Chief Scientific Officer of the Parkinson’s Foundation, a patient might experience masked face even if he does not intend to.

He suggested that people should consult his doctor about screening for Parkinson’s disease if they are told that they looks serious, mad, or depressed even when they feel fine. Besides, those who are targets of the masked face also have reduced eye blinking, stated media reports.

Less Animated By Things

Its these feelings of apathy and a lack of motivation which characterise Marks Parkinsons. In fact, his wife Chrissie noticed these symptoms before he was diagnosed, commenting that Mark seemed less animated by things.

At the same time that Mark was experiencing issues, he was also having trouble with his facial muscles.

I remember going with Chrissie to her appointment when she was diagnosed with breast cancer. Afterwards, she said I appeared unmoved by it all. I couldnt understand it.

Friends and family also commented that Mark looked flat and sad. Eventually, he realised his reduced facial muscles were causing him to experience a Parkinsons mask, which meant he was less able to express himself.

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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.

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

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Understanding Facial Masking And Its Communication Hurdles

Professor Linda Tickle-Degnen and her graduate student researchers are exploring the communication hurdles faced by those with Parkinsons disease and how they can be overcome.

The man in the video sits alone at the Tufts Health Quality of Life Lab speaking to an off-camera voice about, of all things, a wedding he recently attended. On the surface, theres nothing unusual about the conversation, but as the tape goes on, a curious atness in his voice and manner become apparent. Linda Tickle-Degnen, lab director and professor and chair of the School of Arts and Sciences occupational therapy department, lets the video run for a few minutes before she begins pointing things out. She starts with the mans lower body, noting that he hasnt moved or otherwise repositioned himself since the interview began. Next, she calls attention to his left hand, which has been trembling slightly. She ends with his face, but no explanation is necessary: hes remained almost expressionless. To the untrained eye, the man appears disinterested, even bored.

Tickle-Degnen notes that practitioners sometimes fail to talk to the person about their feelings because facial masking consistently causes a perception of depression, deception, hostility, and apathy in practitionerseven when they are experts.

When Might You Have Masked Face With Parkinsons

Parkinsons disease is a chronic, progressive condition. There are five different stages of Parkinsons when certain symptoms may appear or worsen. Masked face can manifest as an early symptom in stage 1.

Masked face severity can progress and worsen as Parkinsons takes hold. According to the Unified Parkinsons Disease Rating Scale, masked face symptoms are categorized from slight to severe. Each masked face stage includes the symptoms of the previous stages, plus new ones. Here is a breakdown of each stage:

• Slight. In this stage, you may blink less often than usual.
• Mild. This stage includes minimal masked facies and less movement in the lower face, including mouth movements and spontaneous smiling. People with mild hypomimia still have the ability to keep their lips closed.
• Moderate. The moderate stage has an increase in masked facies. The lips are held in a parted position for some of the time when the mouth is at rest.
• Severe. Theres an increase in masked facies, and the lips are parted most of the time when the mouth is at rest.

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The Ability Of Patients With Parkinsons Disease To Recognize Masked Faces During Covid

S. Tezcan Aydemir, M. Kuzu Kumcu, N. Durmaz çelik, B. Bakirarar, S. özkan, M. Akbostanc

Category:Parkinson’s Disease: Cognitive functions

Objective: This study aims to evaluate the effect of using masks on face recognition ability in Patients with Parkinsons disease .

Background: Patients with Parkinsons disease suffer from a range of non-motor symptoms such as affective and cognitive disorders, and in the visual perception domain, as well. Among these visual perception difficulties, face recognition problems were reported frequently. Widespread use of masks during COVID-19 pandemic gives a novel opportunity to investigate face recognition disturbances in PwP.

Method: Three groups were included 64 PwP > 24), 58 age and education-matched older healthy controls , and 61 younger healthy controls , aged 30-35. Benton Face Recognition Test-short form , and our close-ended Face recognition difficulties due to using masks during pandemic survey were applied to all groups.

To cite this abstract in AMA style:

Mov Disord.

Learn The Symptoms And Treatments For Facial Masking

• Frequently Asked Questions

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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I Wont Lie There Are Many Down Times But I Have A Choice Do Nothing And Achieve Nothing Or Battle On I Chose The Battle

Does it hinder your creativity?

It makes all the other things that I did, apart from photography, a chore and no longer a means of relaxation. I love drawing but it is so slow and I need to concentrate so hard that the sheer joy of flowing strokes becomes a battle.

How has it affected you outlook on life?

I wont lie, there are many down times but I have a choice do nothing and achieve nothing, or battle on I chose the battle.

Control

Explain the concept behind your Concrete project. Why did you decide to do it?

Since I picked up the camera again, I would occasionally ask my subject if they wouldnt mind placing their face in water and looking at the camera. I just liked the effect. Then early last year it dawned on me, I was making people cry because I wouldnt, couldnt, real men dont cry! So then I thought why not do something with the images to raise awareness of Parkinsons disease. I call it Concrete after a little poem that I wrote.

The photos are incredibly stark representations how did you get the reactions out of your subjects for each emotion?

Facial Masking Can Make It Hard To Gauge The Mood Of A Person With Parkinson’s

Without facial movement, your expression may come across as emotionless, causing you to seem upset or annoyed when you’re not, says physician Chris Airey, MD, medical director at Optimale. He notes that Parkinson’s can affect both voluntary and involuntary facial movements.ae0fcc31ae342fd3a1346ebb1f342fcb

According to the Parkinson’s Foundation, trying to understand a person with Parkinson’s mood can be further complicated byother symptoms on top of facial masking. Facial expressions are an essential part of how we communicate. When you have a straight face along with speech changes, such as a low voice, which is common among Parkinson’s patients, it can be challenging for people to understand your mood, the experts at the foundation explain.

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Parkinson’s Patients With Facial Masking Tend To Have More Severe Orofacial Symptoms

Parkinson’s can present with a wide variety of symptoms, from a loss of smell to a change in handwriting. But Ann Kriebel-Gasparro, DrNP, faculty member for Walden University’s Master of Science in Nursing program, says that research has shown that people with facial masking have more severe orofacial symptoms, meaning those related to the mouth and face. She pointed to a July 2020 study published in the European Journal of Neurology that found that about 70 percent of people with Parkinson’s have facial masking and these patients are more likely to experience impaired speech, swallowing dysfunctions, and drooling.

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