Dementia is a broad term describing a syndrome involving the deterioration of memory, thinking, behavior, and the ability to perform everyday activities. When people ask if dementia changes a person’s face, they are often wondering if the disease causes visible, physical alterations. The answer is complex, involving both indirect physical consequences from the disease’s progression and direct neurological effects that impact facial movement and expression. While the core pathology of dementia does not directly reshape the underlying facial bones or skin, the profound changes it causes in the brain and body can ultimately lead to a distinctly altered appearance.
No Direct Structural Change to Facial Features
Dementia is fundamentally a disease of the brain, characterized by the progressive death of neurons and the accumulation of abnormal protein deposits, such as amyloid plaques and tau tangles in Alzheimer’s disease. This pathology is confined to the central nervous system, and it does not directly target or restructure the physical components of the face. The disease process does not alter the composition of the skin, the shape of the facial bones, or the distribution of fat pads. Therefore, dementia does not cause the face to physically change its inherent structure or contour.
Any perceived change in the face’s physical structure is not a result of the disease attacking the facial tissue itself. However, dementia can be associated with an accelerated aging trajectory that may manifest in the face. Studies have found that people with Alzheimer’s disease often exhibit increased facial asymmetry compared to age-matched individuals without cognitive impairment. This asymmetry is measurable across various facial landmarks. This phenomenon may reflect a faster biological aging process linked to the disease, rather than a direct physical assault on facial structures.
How Secondary Health Issues Alter Appearance
The cognitive and behavioral symptoms of dementia frequently lead to secondary health issues that significantly impact a person’s physical appearance. Difficulties with memory, judgment, and executive function interfere with a person’s ability to maintain self-care and proper nutrition. A noticeable lack of personal hygiene is one of the earliest visual indicators that someone is experiencing major problems with their daily routines.
Poor self-care can result in an unkempt or neglected appearance, including visible skin issues or an inappropriate choice of clothing. Weight fluctuation is also common, as individuals may forget to eat, struggle with the mechanics of preparing or consuming food, or alternatively, overconsume comforting, high-calorie foods. Significant weight loss or weight gain can dramatically change facial fullness and contour.
Dehydration, often resulting from forgetting to drink enough fluids, can quickly alter facial appearance by causing sunken eyes and reduced skin elasticity. Furthermore, many medications prescribed to manage the behavioral and psychological symptoms of dementia can have side effects that alter the face, such as puffiness or skin discoloration. Muscle loss, or sarcopenia, is also associated with an increased risk of dementia, and this systemic atrophy can manifest as a shrinking of the temporalis and jaw muscles, contributing to a thinner, more aged appearance.
The Neurological Impact on Facial Expression and Movement
The most profound and specific changes to the face in dementia are neurological, affecting the control and display of expression rather than the physical structure. Damage to brain regions involved in emotion processing and motor control of the face can lead to a reduction in the ability to display emotion, a condition known as hypomimia or “facial masking”. This reduced expressiveness can make the face appear emotionally flat or apathetic, even when the person may be experiencing internal emotions.
Hypomimia involves fewer overall facial movements, which can include a decreased blink rate, contributing to a blank or staring appearance. This symptom is often linked to changes in neurotransmitters, such as dopamine, which is involved in motor control and emotional response.
Another neurological phenomenon is apraxia of expression, which involves difficulty executing voluntary facial movements like smiling or frowning on command, even though the muscles themselves are functional. This disconnect occurs because the brain’s ability to plan and carry out the movement is impaired. Certain types of dementia, such as Dementia with Lewy Bodies, frequently involve parkinsonism, which includes muscle rigidity and slowness of movement that affects the facial muscles. This rigidity further contributes to the masked, blank expression and reduced range of facial movement.