Swallowing Problems In Parkinson's Disease
An aspect on Parkinson's disease (PD), which does not often receive attention, is the loss of involuntary movement such as armswing while walking, blinking, facial movements and swallowing.
The medical term for swallowing difficulty is dysphagia. Dysphagia and dribbling are more common in the later stages of PD; however, they can occur earlier when associated with other Parkinson disorders.
The loss of the autonomous swallowing movements leads to the pooling of saliva in the month, and there is also a tendency for the closure of the lips to be impaired by dysphagia, resulting into dribbling. There is no increase in the production of saliva; however, it is interesting to note that we produce more than a quart of saliva each day.
Most of the saliva is produced at mealtimes, and the swallowing of food can often help someone with dysphagia, since dribbling may be reduced. With the constant production of saliva, however, between meals, even though at a reduced rate, dribbling can be hard to control.
Swallowing at mealtimes is an issue by itself, with as many as 40 percent of people with dysphagia experiencing 'silent aspiration'. This is when food or drink enters the trachea without eliciting a reflexive cough, thus causing pneumonia.
The following problems may develop during mealtime:
Swallowing hesitation or inability to swallow
Food sticking in the throat
Swallowed food backing up into the nose
Choking
Need of repetitive swallowing
Throat clearing
Coughing after swallowing
Because weight loss is common in Parkinson's it is important to keep an eye out for an eating difficulties and report them to your health professional.
Surprisingly, chewing is usually not a problem. It is more common for eating to be very slow, than for people with dysphagia to experience choking. However, if choking does occur, posture while eating or drinking is important - try to sit upright with the head bent forward.
In order to make mealtimes easier, it might be necessary to change your diet with the help of your medical professional. The following foods may be easier to swallow:
Milk, cream, custard, and yogurt
Omelets and pancakes
Casseroles, soup, and soft boiled rice
Banana and soft fruits
In a few people, usually when Parkinson's has been present for 10-15 years, dribbling is a major problem. It can be socially embarrassing as the person with Parkinson's is well aware of the dribbling but cannot react quickly enough to stop it from occurring.
Medications to dry the mouth do not seem to reduce the dribbling unless the mouth is made unacceptably dry or there are side effects such as blurred vision. The best management may be to use a small towel and/or tissues. In social situations it may be helpful for a caregiver or loved one to sit close to the person with Parkinson's and quickly wipe away any dribble.
Issues with swallowing and dribbling may seem embarrassing or troublesome, but with the help of your health professional and loved one, changes can be made to make mealtimes and social events easier.
This article was adapted from the "Parkinson's Fact Sheet on Swallowing and Dribbling" published in the June 2009 issue of the Parkinsonian, the magazine of Parkinson's New Zealand.
A Healthy Tip of the Month from American Parkinson Disease Association, Inc.