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Masked Facies Parkinson’s Disease

Treatment: Drugs That Make Dopamine


Parkinsons affects nerve cells in your brain that make a chemical called dopamine. As a result, levels of the chemical fall. Doctors usually start treatment with levodopa . Your brain turns it into dopamine. But it can make you sick to your stomach, so youâll probably take it with another medicine called carbidopa to control these side effects. The combination drug is called carbidopa-levodopa .

What Is One Of The First Symptoms Of Parkinsons

Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement. In the early stages of Parkinsons disease, your face may show little or no expression. Your arms may not swing when you walk.

What Organs Does Parkinson Disease Affect

Parkinson’s disease is a degenerative, progressive disorder that affects nerve cells in deep parts of the brain called the basal ganglia and the substantia nigra. Nerve cells in the substantia nigra produce the neurotransmitter dopamine and are responsible for relaying messages that plan and control body movement.

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Facial Masking In Parkinsons Disease In 2021

In this article, you can know about facial masking here are the details below

As such, we tend to utilize the term hypomimia to explain facial masking within the context of Parkinsons illness. It suggests the real loss of motor control rather a physical symptom of psychological blunting.2. Also check salicylic acid.

Can Masked Face Be Treated


There are no specific medications for treating masked face. However, treatments for Parkinsons disease can help reduce masked face, as well as other symptoms of this condition.

Some medications used to treat Parkinsons disease focus on increasing dopamine activity in the brain. Some examples of these medications include carbidopa and levodopa.

Levodopa is one of the main medications used to treat Parkinsons. It is a natural chemical that converts to dopamine in the brain. It is often paired with carbidopa, which helps levodopa work more efficiency and prevents certain side effects like nausea and vomiting.

Together, carbidopa-levodopa can be given as an:

  • oral medication
  • infusion that is administered through a feeding tube directly into the small intestine

Other medications for rigidity, as well as facial exercises and physical therapy, may also be recommended to treat masked face.

Participating in activities that you love or feel passionate about may help improve your facial expressions. This includes creative pursuits, such as singing, dancing, or watching movies and plays.

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What Does Masked Face Mean

Hypomimia is a common symptom of Parkinsons disease. Its included in the Unified Parkinsons Disease Rating Scale as a characteristic that can range from slight to severe.

The face contains 42 individual muscles. These muscles are used, often unconsciously, to display happiness, sadness, confusion, contentment, and many other emotional states.

If you have Parkinsons masked face, your facial motor control isnt working as they usually would. This causes a disconnect between what youre thinking, saying, or feeling with how your face appears to others.

A person with Parkinsons masked face may seem uninterested or uncaring, even when the opposite is true. They may also look angry, sad, or completely free of emotion.

Parkinsons disease can also affect the movements that control your voice, giving you a flat, low monotone. This together with masked face can make it hard to communicate what youre feeling and thinking.

Parkinsons disease affects the brain cells that make dopamine. Dopamine helps control muscle movements, and without enough dopamine, the regulation of movement is impaired. This affects the face as well as other movements throughout the body.

Parkinsons disease can affect the facial movements in several important ways by causing:

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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What Causes Lack Of Facial Expression

Lack of facial expressions is one sign of catatonia, which can occur in association with a psychiatric disorder, like schizophrenia. Diseases that cause damage to the brain and its function can also lead to a lack of responsiveness, including a lack of facial expressions. Examples include brain trauma and encephalitis.

Common Symptoms For These People *:

Parkinson’s disease-pill rolling tremor bradylalia hypomimia (masked facies) reduced eye blinking
  • Gait Disturbance: 16 people, 35.56%
  • Muscle Rigidity : 15 people, 33.33%
  • Tremor : 14 people, 31.11%
  • Fall: 11 people, 24.44%
  • Bradykinesia : 10 people, 22.22%
  • Hallucinations : 8 people, 17.78%
  • Speech Disorder: 7 people, 15.56%
  • Swallowing Difficulty: 7 people, 15.56%
  • Speech Impairment ): 7 people, 15.56%
  • Dyskinesia : 7 people, 15.56%
  • * Approximation only. Some reports may have incomplete information.

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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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    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

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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.

    What Is A Parkinsons Mask

    Parkinsonâs disease: Facial masking an early warning sign

    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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    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

    What Is Facial Masking

    Facial masking affects both voluntary facial movements and involuntary ones . Humans communicate not only through words but through subtle, fast-moving changes in facial expression. An expressionless face, therefore, limits the connection between people.

    When you aren’t able to convey emotions with facial expression, it’s a disadvantage because others may misinterpret words, or be uncertain and confused when expressions don’t match with words.

    The Unified Parkinsons Disease Rating Scale section for facial expression includes a scale to help healthcare providers track the progression of the disorder.

    The UPDRS scale values include:

    • 0 – Normal facial expression
    • 2 – Slight but definitely abnormal loss of facial movement
    • 3 – Moderate loss that is present most of the time
    • 4 – Marked loss that is present most of the time

    It’s important to remember that some people living with Parkinson’s disease also find it difficult to identify emotion in other people’s faces. The inability to recognize sadness, fear, and other emotions also creates an interpersonal barrier and affects quality of life.

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    How To Keep Hypomimia From Affecting Your Health

    Some medications can help treat the movement symptoms that come with hypomimia. These medications also help alleviate the rigidity of your facial muscles but are not a bradykinesia treatment.

    If youâre a caretaker for someone with Parkinsonâs, you might experience the following if your patient has hypomimia:

    • Depression

    The miscommunication that occurs in individuals with hypomimia can take a toll on your health and well-being, too. Parkinsonâs is a condition that progressively worsens and requires good communication to help patients find relief.

    There are some ways that you and your patient or caretaker can work around the stress of hypomimia. Being honest about your inability to make facial expressions is important. So is talking about the lack of facial expressions. If nonverbal cues arenât helping the conversation, speak openly and frankly about your feelings and frustrations. This open communication can help alleviate some tension.

    If youâre having trouble communicating with caretakers or loved ones, you can ask your doctor about a referral to a speech-language pathologist. Theyâll be able to teach you facial expressions that can help treat your amimia.

    A speech-language pathologist will also be able to help you with other problems like swallowing issues or other speech problems.

    Show Sources

    Is Alzheimer’s Worse Than Parkinson’s

    Masked Face for Parkinson’s Disease | Dr Paresh Doshi

    A Parkinson’s patient may have their memory intact but have a problem walking straight or moving their body. An Alzheimer’s patient loses both their cognitive function and ability to do anything for their own. When you look at it from this perspective, then Alzheimer’s is usually considered worse off than Parkinson’s.

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    A Note For Caregivers

    Caregivers can be challenged by the increasing needs of a declining Parkinsons patient. It is important that caregivers have a good concept of this progressive disease. Support groups are available to help caregivers understand the disease process and how to cope with the various problems they face in caring for a Parkinsons disease patient.

    Additional Information on Parkinsons Disease

    For more information about Parkinsons Disease, please consider the following:

  • James Cavallini / Photo Researchers, Inc.
  • EPA/POOL/Corbis
  • Simon Fraser / Royal Victoria Infirmary, Newcastle upon Tyne / Photo Researchers, Inc
  • Travis Price/Flickr Select
  • Dennis Kunkel Microscopy, Inc. / Phototake, Roger Harris/Photo Researchers Inc
  • Leonard Lessin/Photo Researchers Inc
  • John Lund/Photographers Choice
  • 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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    How Is Hypomimia Diagnosed

    There’s no specific diagnosis for hypomimia. Sometimes, this condition can go unnoticed, and the person experiencing the condition can simply come off as cold or unemotional towards others.

    You, meanwhile, may not even notice that your facial expressions or lack thereof affect your communication abilities. You will need open communication between loved ones to tell you if your facial expressions are coming off the right way in conversations.

    Hypomimia is a common characteristic of Parkinsonâs disease. Often, hypomimia might be noticed even before a clinical diagnosis of Parkinsonâs disease.

    Therapy For Masked Facies

    Pin on Sistema nervioso

    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

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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.ae0fcc31ae342fd3a1346ebb1f342fcb

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    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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