In humans, the neural circuitry underlying facial expressions differs,
depending on whether facial expressions are spontaneously (i.e., limbic,
subcortical) or voluntarily initiated (i.e., frontal cortex). Previous
investigators have suggested that the “masked face” of
Parkinson's disease involves spontaneous, but not intentional, facial
expressions. In contrast, we hypothesized that intentional facial
expressions may be slowed (bradykinetic) and involve less movement, in
much the same way that other intentional movements are affected by
Parkinson's disease. To test this hypothesis, we used sophisticated
computer imaging techniques to quantify dynamic facial movement. Relative
to controls, Parkinson patients had reduced facial movement (entropy) and
were significantly slowed in reaching a peak expression (i.e.,
bradykinesia). These findings are consistent with the view that the basal
ganglia play a role in affecting intentional facial movements. This
possibly occurs because of diminished efficiency and/or activation of
face representation areas in the frontal cortical regions (i.e., motor,
premotor, and supplementary motor area) or because of movement-based
suppression secondary to dopaminergic reduction in frontostriatal
pathways. Taken together, the characterization of Parkinson's disease
as a model system for the neuroanatomic dissociation between voluntary and
spontaneous expressions may be unjustified. (JINS, 2006,
12, 765–773.)