Mask-Like Expression (hypomimia)
Reviewed by: HU Medical Review Board | Last updated: May 2022
People with Parkinson's disease (PD) can experience different symptoms, and these symptoms can vary in severity. Some people with PD experience a mask-like expression as a motor (movement) symptom of the disease. This means their face has less facial movements and appears less animated.1,2
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 (stiffness) of the limbs and trunk
- Difficulty balancing (postural instability)
- Slowness of movement (bradykinesia)
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 (facial masking)
- Trouble producing emotional speech (dysarthria)
- 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
Why is it challenging?
Much of our communication is non-verbal. Emotions and feelings are "read" on our faces by others. People with PD who have facial masking may seem unapproachable or mean. This can lead to social isolation and a wide range of feelings, from sadness to frustration.3,4
When facial masking is combined with other problems in PD, like speech issues, communication can be further challenged.3,4
Why does PD cause a mask-like expression?
Dopamine is a chemical messenger (neurotransmitter) 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
There is currently no cure for PD. The main goal of treatment is to reduce symptoms and help manage motor function and communication problems. Treatment includes medicines, surgery, rehabilitation, and alternative therapies.1,2
Drugs like levodopa that treat the movement problems in PD often help with facial masking. A speech therapist can be helpful in teaching you facial exercises that may eliminate some tension and relieve some of the symptoms. These experts can help you with any speech or swallowing problems you might have, which is also common in PD.1,2
The mask-like expression can be hiding a face that wants to smile, laugh, cry, or show other emotions. Feeling a lack of control in how you present yourself can be distressing and depressing. Mood changes are common in PD, but your mental health is important. Talk to your doctor about your emotions, mood, and mental health.
With treatment, planning, and expert care, you can learn to overcome mask-like expressions. Talk to your friends and family about your symptoms and why you might not look as animated as you used to. Your support system wants the best for you and will be there when you need them the most.3,4