Dysphagia in Parkinson's

Dysphagia Facts

Due to the progressive loss of muscle control – both voluntary and involuntary – many other symptoms can develop in a patient suffering from Parkinson’s disease besides the typical symptoms of tremor and rigidity. Dysphagia is one such symptom. Dysphagia or difficulty in swallowing is a common problem in people with Parkinson’s disease which can have far-reaching consequences.

Dysphagia can lead to shorter survival time in a patient with Parkinson’s disease, not only because the affected muscles of the throat may make swallowing difficult – hence less food intake and increased chances of under-nutrition of the patient – but also because it increases the possibility of aspiration pneumonia.

How does dysphagia occur?

The act of swallowing can be divided into 3 phases – oral, pharyngeal and esophageal. Parkinson’s disease patients usually have problems with the first 2 stages of swallowing, which means that their dysphagia is of the oropharyngeal type. Weak tongue or cheek muscles make moving food around in the mouth difficult and can hamper chewing. Along with that, the weak throat muscles cannot sufficiently move the food towards the esophagus.

Causes of Dysphagia in Parkinson’s Disease

A number of factors may contribute to swallowing problems in Parkinson’s disease.

1. Motor impairment of the throat muscles as a result of Parkinson’s disease.
2. Dysphagia can be made worse by lack of saliva or dry mouth. This is common in Parkinson’s disease patients, frequently related to anticholinergics medication.
3. Since Parkinson’s disease is more common in the elderly, associated features such as poor dentition can play a role.

Diagnosis of dysphagia in Parkinson’s Disease

When a person with Parkinson’s disease has problems with swallowing, a proper history and examination of the patient will help to determine the severity of dysphagia and evaluate the risk of aspiration. This is usually done by the doctor as well as a speech-language pathologist. Certain tests may also be done such as:

1. Modified Barium Swallow Study.
2. Endoscopy.
3. Barium Swallow.

Complications of dysphagia in Parkinson’s Disease

• Food and saliva which cannot be swallowed may collect in the mouth or back of the throat and cause choking, coughing or drooling.
• Aspiration pneumonia – due to food or liquids being inhaled into the lungs.
• Weight loss – this can be an indicator of the severity and duration of dysphagia.
• Malnutrition.
• Shorter survival time in a patient with Parkinson’s disease.
• Apart from the physical problems faced due to dysphagia, certain psychosocial problems may also occur. Difficulty in swallowing can make patients dread meal times. The fear of choking is very real in some people. There is less enjoyment of food, especially due to the adjustments needed regarding the type of food that can be easily swallowed. Social adjustments, such as avoiding guests during meal times or going out to dinner can take its toll, both on the patient as well as the care-giver.

Treatment of dysphagia in Parkinson’s Disease

• Intensive swallowing therapy by a speech-language pathologist can help to overcome the weakness in the swallowing apparatus by strengthening exercises or compensatory maneuvers.
• Sitting up straight and keeping the head slightly forward while eating may help.
• Modifications in diet, such as eating soft and pureed food can help.
• Gastric feeding tube in end stages of the disease may become necessary.