Parkinson's Disease & swallowing

By Renee Taylor - Speech Language Therapist

Parkinson’s Disease (PD) is one of the more well-known progressive neurodegenerative conditions due in part to Mike J Fox and Muhammad Ali. Attention often focuses on the motor/movement features of PD, however non-motor features may also become involved e.g. changes in behavior, sleep, and sensation (1).  

Swallowing and saliva difficulties are common symptoms that are associated with PD which can greatly impact quality of life (2). Some people find that eating and swallowing can be difficult due to a change in muscle strength and coordination. However swallowing difficulties aren’t always obvious to someone with PD. If food or fluid enters the windpipe then our body should reflexively cough to prevent it from entering the lungs. However some people with PD have SILENT ASPIRATION which means that food and fluid may enter the wind pipe and lungs without any sign of coughing/choking. This can lead to aspiration pneumonia.

Drooling and a dry mouth are also common complaints in PD.  People with PD produce less saliva, this combined with some medications can contribute to developing a dry mouth (3) Despite having a dry mouth, many people with PD also report ‘excess’ saliva or drooling. This has to do with the automatic swallowing mechanism which starts to slow down and can result in pooling of saliva in the mouth. So, it is not that there is an increase in saliva production, but rather that it is not swallowed and cleared as regularly (3). These are all normal but frustrating symptoms of PD, and although there is no cure for the condition, there are environmental, therapeutic, and medical interventions that can assist in relieving some of these difficulties.

It is important to know that there is help to overcome swallowing and saliva difficulties. Your Speech-language Therapist, GP, and Parkinson’s NZ, can provide you with the support and information you will need.

Tips when swallowing:

  • When you swallow, try to squeeze hard with all of the muscles in your mouth and throat. This will help to get food down into your stomach.
  • Try licking with your tongue round your mouth to check all the food is gone
  • Try refilling your cup or glass when it is half empty, so you do not have to tilt your head back to drink. Tilting your head backwards can sometimes make food or fluids go down the wrong way.
  • You can also use modified cups that are shaped to allow you to drink without tilting your head. Your Occupational Therapist can advise you on this.
  • Very cold liquids can stimulate a swallow and can be useful first thing before breakfast or with a meal. Thicker drinks move more slowly and are easier to control for some people. Your Speech-language Therapist will be able to assess you and advise on this.
  • You may need to consider having softer foods. Your Speech-language Therapist will be able to assess you and advise on this.

Tips for saliva management:

  • Practice sucking in the corners of your mouth. Swallow any saliva present.
  • Develop a habit of sucking and swallowing every few minutes to remove saliva from your mouth.
  • Try to keep your lips closed to keep the saliva in your mouth. Practice pressing your lips hard together.
  • Keep your head upright, not dropped forward. Think ‘tall’.
  • Always swallow before speaking, or changing your position e.g. leaning forward or standing up.
  • Try to avoid continually wiping your mouth, as this can make it sore. Suck and swallow instead. If you do need to wipe your mouth or chin, ‘dab’ or ‘blot’ rather than wipe.

Tips for a dry mouth:

  • Chew some sugar free gum or suck a sweet to encourage saliva production.
  • Use mouth washes to cleanse and relieve the dryness. You can make a simple but effective mouth wash by dissolving ¼ teaspoon each of bicarbonate of soda and table salt in warm water.
  • Use lip salve on your lips to prevent them from becoming cracked.
  • Take regular sips of fluid throughout the day. Avoid strong tea and coffee, as these act as diuretics.
  • Artificial saliva is available in spray and gel forms from the pharmacy.

References

  1. Edwards LL, Quigley EM, Pfeiffer RF. Gastrointestinal dysfunction in Parkinson's disease: frequency and pathophysiology. Neurology 1992; 42: 726–732.
  2. Wang CM, Sheih WY, Weng YH, Hsu YH, Wu YR. Non-invasive assessment determine the swallowing and respiration dysfunction in elderly Parkinson’s disease. Parkinsonism & Related Disorders 2017; available online 26 May.
  3. Proulx M, De Courval FP, Wiseman MA, Panisett M. Salivary Production in Parkinson’s Disease. Movement Disorders 2005; 20: 204-207.

1 comment

corina

Thanks Renee!

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