Micrographia

Reviewed by: HU Medical Review Board | Last updated: December 2022

Micrographia is the medical term for a small handwriting size. It may be caused by various conditions. These include brain and muscle disorders, nervousness about writing, arthritis, or injury to the hands or fingers. Micrographia is a common symptom among people with Parkinson's disease (PD). Up to half of people with PD also deal with micrographia.1,2

People with PD may experience various writing problems, including:1,2

  • Writing that is smaller than usual
  • Writing that is hard to read because it changes slope and direction
  • Difficulty forming letters or writing words correctly despite average muscle power, sensation, and coordination
  • Writing that is often interrupted by pauses for rest

Why does PD affect writing?

Micrographia is caused by the same damage in the brain that leads to PD's other motor (movement) symptoms. The other motor symptoms in PD all make it harder to write. They include:1,2

  • Slowness of movement
  • Tremor
  • Rigidity

Treatment

There is no cure for Parkinson's disease. And no drug is known to stop or slow PD's progression. But treatments are available that can help manage symptoms:1

Occupational therapy can help assist and train you to live as independently as possible. Even if you feel you are performing your daily tasks without the need for help, these experts are great at increasing your independence.3

Tips for managing small handwriting:1,2

  • Practice writing regularly
  • Try different size pencils and pens to see which ones work better
  • Ask your doctor for a referral to an occupational therapist

Handwriting training

A 2018 study found that 6 weeks of intense handwriting training can retrain and essentially rewire the brain’s connections in people with PD. Those who received intense handwriting training showed significant changes in their brain’s cerebral cortex. The cerebral cortex helps control muscle movement like handwriting. 4

This study showed that handwriting training could help people with PD retrain their brains to make new connections and improve writing. While exciting news, more research is needed to prove this treatment is effective for all people with PD.4

Keeping your signature up to date

Your signature may change over time as your handwriting changes. Because your signature is an essential part of legal documents, you may find it challenging when your signature looks different from day to day.1

One way to solve this might be to have an attorney prepare formal papers for you to sign at different times of the day. These can be notarized and will show changes in your signature that you can document and provide to places like your bank or medical office if needed.1

Other resources

The Parkinson’s Cards to Heroes program will give you the practice you need. And you will be serving your community in the process! You can:2

  • Request your kit online
  • Write a letter to a hero in your community
  • Practice your handwriting

Send a hand-written note to your family member instead of an email. Start journaling at night. Jot down a to-do list of priorities. Practice makes perfect, and writing is no different.2

Parkinson’s disease has its challenges. Your writing may change over time, but you can find ways to manage it. Talk to your doctor and occupational therapist about creative ways to manage your handwriting as your PD progresses.2

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