Micrographia: A Distinctive Sign of Parkinson's Disease

Woman writing note
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Handwriting that's getting progressively smaller — something doctors call "micrographia" — probably doesn't seem like a major problem. But if your handwriting is smaller than it used to be and getting smaller still, it could be a symptom of a serious medical condition: Parkinson's disease.

Parkinson's disease is a brain disease that causes loss of balance, stiffness and slow movement. It's progressive, which means it will tend to get worse over time, and it can't be cured.

However, there are treatments available that can help to keep your symptoms under control.

Micrographia is one of those symptoms, and in fact it can be an early warning sign of Parkinson's. People with Parkinson's disease tend to find their handwriting gets smaller, even though they don't intend to write smaller.

In Parkinson's, the words you write may be closer together on the page (even crowded together so that they're difficult to read), and your letter sizes may be smaller, too. Finally, your writing may tilt upward to the right on the page. All these are signs of micrographia.

Who Has Micrographia?

Micrographia has other possible causes, including stroke, but most of those who develop this particular handwriting problem have Parkinson's disease.

In one study, researchers found micrographia in close to half of all Parkinson's disease patients. That study, which was conducted at a U.S. Veterans Administration hospital and included only men, found that those with smaller-than-normal handwriting were also more likely to have worse overall Parkinson's symptoms, and to have problems thinking and concentrating (which can be related to Parkinson's).

 

People with micrographia also were more likely to have more slowness of movement (a problem doctors call "bradykinesia") and a weak voice (what doctors call "hypophonia").

Fixing Smaller-than-Normal Handwriting

Some doctors and therapists have worked with people who have Parkinson's disease in an effort to improve their handwriting, with some limited success.

In one study, conducted in Buenos Aires, Argentina, 30 people with Parkinson's disease participated in once-weekly handwriting training sessions for nine weeks. Each session was 90 minutes long, and aimed to train the people to use bolder, broader strokes (often with wide-tip pens) and to use their shoulder muscles to write.

At the end of the training sessions, those who had attended wrote bigger versions of the letter "e" and also used more space on the page for their signatures. They also tended towards slightly larger letter sizes. Unfortunately, they still wrote smaller letters, and their writing still tended to tilt upward to the right of the page.

Research also has shown that people with Parkinson's disease may improve their handwriting if they are reminded — either through visual cues or verbal prompts — to make their letters bigger while they're writing.

Sources:

Bryant MS et al. An investigation of two interventions for micrographia in individuals with Parkinson's disease. Clinical Rehabilitation. 2010 Nov;24(11):1021-6.

Ma HI et al. Progressive micrographia shown in horizontal, but not vertical, writing in Parkinson's disease. Behavioural Neurology. 2013;27(2):169-74.

Wagle Shukla A et al. Micrographia and related deficits in Parkinson's disease: a cross-sectional study. BMJ Open. 2016 Jan 18.

Ziliotto A et al. Handwriting Rehabilitation in Parkinson Disease: A Pilot Study. Annals of Rehabilitation Medicine. 2015 Aug;39(4):586-91.

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