If you think your loved one with Alzheimer’s disease looks different, you might be right. Several members of myALZteam have noticed changes in their loved one’s face or facial expressions.

Some changes are behavioral. “My mother-in-law sucks in her cheeks, so her lower lip puckers all the time,” said one member. “For the last couple of days, she hasn’t swallowed, and saliva has accumulated in her mouth.”

Another noticed changes in their loved one’s habits: “He has just started walking around the garden with his hands clenched in his pockets and his bottom lip protruding. Looks like a little boy sulking. He seems happy enough puttering around.”

“I’ve also noticed my husband also protrudes his lower lip a lot. I’ve never figured that out,” responded another.

Others believe facial changes reflect the emotional struggles of their loved one. One member shared, “I’ve attributed some of Mom’s facial physical changes to the stress she is under. She’s mourning her memory, my dad, and her retirement.”

Here are some of the ways Alzheimer’s can impact the face and what this could mean for early detection and research.

Facial Symmetry and Muscle Loss in Older People

Research suggests that people with Alzheimer’s disease may appear older than they are. In older adults, faces tend to become less symmetrical with age. In one small study, facial asymmetry was more pronounced in people with dementia compared to their peers with normal cognition. This could be related to faster brain aging as a result of the disease.

Muscle loss or atrophy can also be an early sign that someone is at risk for Alzheimer’s disease. This includes the muscles of the face. One study found that people with muscle loss had a 60 percent higher chance of developing Alzheimer’s. Researchers looked at the head muscle that controls jaw movement. Since the face has so many muscles, losing muscle mass or tone could lead to:

• Drooping
• Thinness
• Other visible changes

By measuring thickness in this particular muscle that controls the jaw, healthcare providers may be able to estimate muscle loss in other parts of the body. They can get this information by looking at routine brain scans used for people with symptoms of dementia. This could help reduce the need for additional testing and lower medical costs.

Scientists are also exploring new technology to map facial changes and help with the early detection of Alzheimer’s. While still in development, these tools could lead to faster diagnoses and earlier access to treatment.

How Brain Changes Impact Facial Expressions

Hypomimia is the term for reduced facial expressions. It’s sometimes called facial masking. This symptom is common in people with neurological conditions that affect the brain, including Parkinson’s disease and Alzheimer’s disease. In one small study, over half of the participants with Alzheimer’s disease had hypomimia.

People with hypomimia may:

• Show fewer facial movements (even blinking less)
• Appear emotionally flat (apathetic)
• Struggle to convey feelings

Scientists believe hypomimia may be related to changes in the brain chemical dopamine. A lowered response to dopamine could help explain why people with Alzheimer’s seem to feel and express less emotion.

Other research has found that people with mild cognitive impairment often show more exaggerated negative emotions on their faces. However, as Alzheimer’s disease progresses beyond the early stages, the ability to express both positive and negative emotions tends to decrease. This can make it harder for caregivers and healthcare providers to know if the person is upset or in pain.

Challenges That Come With Facial Changes

Noticing changes to your loved one’s facial features and expressions can be heartbreaking — a visible sign of dementia. It’s normal to worry about changes in brain function and what they could mean for daily life going forward. Many caregivers find it especially difficult when their loved one’s face no longer reflects familiar emotions.

Members of myALZteam have said that staying focused on the present helps them avoid stress about the future. “There’s always the unknowns, but we have to focus on the here and now. I used to wonder about the ‘what ifs?’ with my dad, and they didn’t happen. I tried to spend more time with him while I still had him mentally there,” shared one member.

As Alzheimer’s disease advances, verbal communication often declines. If someone is already speaking less often or losing their train of thought, caregivers may rely on nonverbal cues like facial expressions and gestures to understand how they’re feeling. However, facial masking makes this even harder.

Be a patient listener and allow extra time for responses. Sometimes, just being present with your loved one gives them validation and reassurance, even when you’re not sure how they’re feeling.

In addition, pain is a common symptom for people with Alzheimer’s disease and other forms of dementia. Unfortunately, many people with Alzheimer’s experience pain but can’t express it, which means they may not get the treatment they need. Untreated pain can lead to withdrawal, fatigue, or negative behaviors.

Assessing someone’s level of pain can be a challenge, especially in the more advanced stages of Alzheimer’s disease. If you suspect that your loved one may be in pain, work with their healthcare team to assess discomfort and help get the care they need.

Talk With Others Who Understand

On myALZteam, the social network for people with Alzheimer’s disease and their family members and caregivers, members come together to ask questions, give advice, and share stories with others who understand life with Alzheimer’s disease.

Have you noticed changes to your loved one’s face or facial expressions? If so, how do you think these have affected their ability to communicate and quality of life? Share in the comments below, or start a conversation by posting on your Activities page.