Table of ContentsView AllTable of ContentsWhat Is Facial Masking?Masked Face and Parkinson’sTherapy for Facial MaskingFacial Masking and MedicationFrequently Asked Questions

Table of ContentsView All

View All

Table of Contents

What Is Facial Masking?

Masked Face and Parkinson’s

Therapy for Facial Masking

Facial Masking and Medication

Frequently Asked Questions

Facial masking, also called masked facies or hypomimia, is the loss of facial expression most commonly associated withParkinson’s disease. The condition gives the affected person a fixed, mask-like expression.

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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Man experiencing facial masking due to Parkinson’s Disease

Facial masking affects both voluntary facial movements (such as a smile) and involuntary ones (such as occurs when a person is startled). 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 Parkinson’s Disease Rating Scale (UPDRS) section for facial expression includes a scale to help healthcare providers track the progression of the disorder.

The UPDRS scale values include:

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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Facial masking is symptomatic of the degenerative nature of Parkinson’s disease. The hallmark feature of the disease is the progressive loss of motor control.

This loss of control affects major limbs, but it also affects the finer muscle movement of the hands, mouth, tongue, and face. Facial masking affects some 70% of people living with a Parkinson’s diagnosis.

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1:37Click Play to Learn All About Facial Masking in Parkinson’s

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Click Play to Learn All About Facial Masking in Parkinson’s

Facial expression matters. Research has shown that quality of life is better in persons with Parkinson’s who have undergone therapy to improve facial control than those who have not.

Therapy 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.

The LSVT technique and similar rehabilitative approaches (such as choir singing or voice amplification) have proven valuable in helping people living with Parkinson’s to isolate and control specific facial muscles more effectively when communicating in groups or one-on-one.

Some medications have been found to improve symptoms of a masked face with Parkinson’s disease. They include levodopa (L-dopa), a drug often used to replace dopamine. Researchers have demonstrated a link between facial masking symptoms and low dopamine responses.

Because levodopa alone leads to side effects of nausea and vomiting, it’s usually given as a combined drug with carbidopa, such as Sinemet or Parcopa.

For some people, a surgically implanted device in the abdomen will deliver Duopa, a carbidopa-levodopa combination that is continually administered and reduces what’s known as “off time,” when drug benefits are reduced.

Other medications used to treat facial masking include:

Other drugs, such as catechol-o-methyl transferase (COMT) inhibitors and monoamine oxidase type B (MAO-B) inhibitors, may be used to boost the effects of levodopa.

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Parkinson’s disease typically affects people over age 60, though it can happen earlier. It affects more males than females. There is some evidence that it runs in families.People with melanoma cancers also appear more likely to develop PD, and people with PD are at higher risk for melanoma.Learn MoreParkinson’s Disease Facts and Statistics: What You Need to Know

Parkinson’s disease typically affects people over age 60, though it can happen earlier. It affects more males than females. There is some evidence that it runs in families.People with melanoma cancers also appear more likely to develop PD, and people with PD are at higher risk for melanoma.

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Young-onset Parkinson’s disease can develop between the ages of 21 and 55, and in rare cases even younger. These people will live longer with the disease, so it’s important to have a healthcare provider diagnosis and begin treating symptoms as soon as possibleLearn MoreDo Only Old People Get Parkinson’s Disease?

Young-onset Parkinson’s disease can develop between the ages of 21 and 55, and in rare cases even younger. These people will live longer with the disease, so it’s important to have a healthcare provider diagnosis and begin treating symptoms as soon as possible

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8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ricciardi, L.; Baggio, P.; Ricciardi, D. et al.Rehabilitation of Hypomimia in Parkinson’s Disease: A feasibility study of two different approaches.Neurological Sciences.2016;37(3);431-6. doi:10.1007/s10072-015-2421-9Argaud S, Vérin M, Sauleau P, Grandjean D.Facial emotion recognition in Parkinson’s disease: A review and new hypotheses.Mov Disord. 2018 Apr;33(4):554-567. doi:10.1002/mds.27305Ricciardi L, De Angelis A, Marsili L, Faiman I, Pradhan P, Pereira EA,et al.Hypomimia in Parkinson’s disease: an axial sign responsive to levodopa.Eur J Neurol. 2020 Dec;27(12):2422-2429. doi:10.1111/ene.14452.Dumer, A.; Oster, H.; McCabe, D. et al.Effects of the Lee Silverman Voice Treatment (LSVT LOUD) on Hypomimia in Parkinson’s disease.Journal of the International Neuropsychological Society. 2014;20(3):302-12. doi:10.1017/S1355617714000046Parkinson’s Foundation.Levodopa.American Parkinson Disease Association.Common symptoms of Parkinson’s disease.Pagano G, Ferrara N, Brooks DJ, Pavese N.Age at onset and Parkinson disease phenotype.Neurology.2016;86(15):1400-1407. doi:10.1212/WNL.0000000000002461Ye Q, Wen Y, Al-Kuwari N, Chen X.Association Between Parkinson’s Disease and Melanoma: Putting the Pieces Together.Front Aging Neurosci. 2020 Mar 10;12:60. doi:10.3389/fnagi.2020.00060.

8 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ricciardi, L.; Baggio, P.; Ricciardi, D. et al.Rehabilitation of Hypomimia in Parkinson’s Disease: A feasibility study of two different approaches.Neurological Sciences.2016;37(3);431-6. doi:10.1007/s10072-015-2421-9Argaud S, Vérin M, Sauleau P, Grandjean D.Facial emotion recognition in Parkinson’s disease: A review and new hypotheses.Mov Disord. 2018 Apr;33(4):554-567. doi:10.1002/mds.27305Ricciardi L, De Angelis A, Marsili L, Faiman I, Pradhan P, Pereira EA,et al.Hypomimia in Parkinson’s disease: an axial sign responsive to levodopa.Eur J Neurol. 2020 Dec;27(12):2422-2429. doi:10.1111/ene.14452.Dumer, A.; Oster, H.; McCabe, D. et al.Effects of the Lee Silverman Voice Treatment (LSVT LOUD) on Hypomimia in Parkinson’s disease.Journal of the International Neuropsychological Society. 2014;20(3):302-12. doi:10.1017/S1355617714000046Parkinson’s Foundation.Levodopa.American Parkinson Disease Association.Common symptoms of Parkinson’s disease.Pagano G, Ferrara N, Brooks DJ, Pavese N.Age at onset and Parkinson disease phenotype.Neurology.2016;86(15):1400-1407. doi:10.1212/WNL.0000000000002461Ye Q, Wen Y, Al-Kuwari N, Chen X.Association Between Parkinson’s Disease and Melanoma: Putting the Pieces Together.Front Aging Neurosci. 2020 Mar 10;12:60. doi:10.3389/fnagi.2020.00060.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Ricciardi, L.; Baggio, P.; Ricciardi, D. et al.Rehabilitation of Hypomimia in Parkinson’s Disease: A feasibility study of two different approaches.Neurological Sciences.2016;37(3);431-6. doi:10.1007/s10072-015-2421-9Argaud S, Vérin M, Sauleau P, Grandjean D.Facial emotion recognition in Parkinson’s disease: A review and new hypotheses.Mov Disord. 2018 Apr;33(4):554-567. doi:10.1002/mds.27305Ricciardi L, De Angelis A, Marsili L, Faiman I, Pradhan P, Pereira EA,et al.Hypomimia in Parkinson’s disease: an axial sign responsive to levodopa.Eur J Neurol. 2020 Dec;27(12):2422-2429. doi:10.1111/ene.14452.Dumer, A.; Oster, H.; McCabe, D. et al.Effects of the Lee Silverman Voice Treatment (LSVT LOUD) on Hypomimia in Parkinson’s disease.Journal of the International Neuropsychological Society. 2014;20(3):302-12. doi:10.1017/S1355617714000046Parkinson’s Foundation.Levodopa.American Parkinson Disease Association.Common symptoms of Parkinson’s disease.Pagano G, Ferrara N, Brooks DJ, Pavese N.Age at onset and Parkinson disease phenotype.Neurology.2016;86(15):1400-1407. doi:10.1212/WNL.0000000000002461Ye Q, Wen Y, Al-Kuwari N, Chen X.Association Between Parkinson’s Disease and Melanoma: Putting the Pieces Together.Front Aging Neurosci. 2020 Mar 10;12:60. doi:10.3389/fnagi.2020.00060.

Ricciardi, L.; Baggio, P.; Ricciardi, D. et al.Rehabilitation of Hypomimia in Parkinson’s Disease: A feasibility study of two different approaches.Neurological Sciences.2016;37(3);431-6. doi:10.1007/s10072-015-2421-9

Argaud S, Vérin M, Sauleau P, Grandjean D.Facial emotion recognition in Parkinson’s disease: A review and new hypotheses.Mov Disord. 2018 Apr;33(4):554-567. doi:10.1002/mds.27305

Ricciardi L, De Angelis A, Marsili L, Faiman I, Pradhan P, Pereira EA,et al.Hypomimia in Parkinson’s disease: an axial sign responsive to levodopa.Eur J Neurol. 2020 Dec;27(12):2422-2429. doi:10.1111/ene.14452.

Dumer, A.; Oster, H.; McCabe, D. et al.Effects of the Lee Silverman Voice Treatment (LSVT LOUD) on Hypomimia in Parkinson’s disease.Journal of the International Neuropsychological Society. 2014;20(3):302-12. doi:10.1017/S1355617714000046

Parkinson’s Foundation.Levodopa.

American Parkinson Disease Association.Common symptoms of Parkinson’s disease.

Pagano G, Ferrara N, Brooks DJ, Pavese N.Age at onset and Parkinson disease phenotype.Neurology.2016;86(15):1400-1407. doi:10.1212/WNL.0000000000002461

Ye Q, Wen Y, Al-Kuwari N, Chen X.Association Between Parkinson’s Disease and Melanoma: Putting the Pieces Together.Front Aging Neurosci. 2020 Mar 10;12:60. doi:10.3389/fnagi.2020.00060.

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