Symptoms – Micrographia


Micrographia is abnormally small or cramped handwriting. It is a secondary motor symptom experienced by some people with Parkinson’s disease (PD). Micrographia is often an early symptom of the disease. Not everyone with PD has the same symptoms, and not all people with PD experience micrographia. One study found that about half of all people with PD have micrographia as one of their symptoms.1,2

PD is a chronic, progressive disease, and micrographia appears to worsen as the condition progresses, causing handwriting to shrink in size. Micrographia is believed to be a result of bradykinesia, the slowing down and loss of spontaneous movement that is one of the four primary motor symptoms of PD.1,2 However, micrographia can be apparent at the initial onset of the disease even without significant bradykinesia.

Why does Parkinson’s disease cause micrographia?

PD damages many areas of the brain. Scientists believe that PD’s effects on the basal ganglia and the cortex of the brain cause bradykinesia, which can lead to micrographia. The basal ganglia are a group of neurons (nerve cells) located deep in the brain that process information on movement and play an important role in planning actions to achieve specific goals, such as using hands to catch a ball or write with a pen. The basal ganglia work in cooperation with the cortex (the outer, convoluted portion of the brain) to signal and activate muscles. As PD progresses, the impulses from the basal ganglia are insufficient to prepare and execute the commands to move. Several additional factors that contribute to bradykinesia in people with PD include muscle weakness, rigidity, tremor, movement variability (movements are less accurate than normal), and slowing of thought.3,4

Treating micrographia in Parkinson’s disease

Currently, no cure exists for PD, and there are no known treatments to stop or slow the progression of the disease. Treatments are available that help manage the symptoms and may include medications (like levodopa), surgery (deep brain stimulation), and complementary or alternative medicine.5 However, levodopa does not always improve all aspects of micrographia such as a gradual reduction in the size of handwriting while writing.

Improving micrographia by closing eyes while writing

One study found that micrographia was improved in people with PD when they closed their eyes while writing. Closing the eyes took away the visual feedback that is normally present, and this simple activity seemed to improve micrographia, particularly among people with PD who were not taking medication for PD. Following the clinical trial, the study authors noted that many of the study participants continued to use this method of closing their eyes while writing, especially when writing their signature.6

Other symptoms of Parkinson’s disease

The primary motor symptoms of PD are tremor, rigidity, postural instability (impaired balance), and bradykinesia. PD also causes many secondary motor symptoms, including changes in gait (way of walking), changes in speech, stooped posture, dystonia (muscle contractions that cause twisting), cramping, difficulty swallowing, sexual dysfunction, impaired fine motor dexterity, and akathisia (restless movement). In addition to these motor symptoms, PD can cause non-motor symptoms such as depression, difficulty swallowing or chewing, urinary problems, constipation, skin problems, sleep problems, pain, and cognitive problems, such as memory problems or slow thinking.1,7

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view references
  1. Parkinson’s Disease Foundation. Accessed online on 12/19/16 at
  2. Shukla AW, Ounpraseuth S, Okun MS, Gray V, Schwankhaus J, Metzer WS. Micrographia and related deficits in Parkinson's disease: a cross-sectional study. BMJ Open 2012;2:e000628. doi:10.1136/bmjopen-2011-000628
  3. Berardelli A, Rothwell JC, Thompson PD, Hallett M. Pathophysiology of bradykinesia in Parkinson’s disease. Brain. 2001;124:2131–2146.
  4. Basal ganglia, Encyclopaedia Brittannica. Accessed online on 12/16/16 at
  5. Gazewood JD, Richards DR, Clebak K. Parkinson disease: an update. Am Fam Physician. 2013 Feb 15;87(4):267-73.
  6. Ondo, W. G. and Satija, P. Withdrawal of visual feedback improves micrographia in Parkinson's disease. Mov. Disord. 2007;22:2130–2131. doi:10.1002/mds.21733
  7. Parkinson’s Disease. NIH Publication No. 15-139. Dec 2014. National Institute of Neurological Disorders and Stroke, National Institutes of Health.
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Written by: Emily Downward | Last reviewed: March 2017
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