Swallowing Difficulties and Parkinson’s Disease
Swallowing difficulties are common in individuals with Parkinson’s Disease, affecting more than 80% of people with the condition. While the underlying pathophysiology is poorly understood, changes in dopamine levels, as well as weakened muscles, reduced reflexes and sensation in the throat are considered to affect how effectively individuals with Parkinson’s Disease can swallow food and drinks. This swallowing difficulty is also referred to as Dysphagia.
At Speak and Swallow, our Speech Pathologists work alongside adults in the community at all stages of their Parkinson’s journey. We address swallowing difficulties associated with Parkinson’s Disease with a combination of clinical swallow assessments, instrumental assessments, and targeted dysphagia therapy. Keep on reading to learn more about swallowing changes and Parkinson’s Disease.
What We Know About Swallowing Difficulties and Parkinson’s Disease
As Parkinson’s Disease is a progressive neurological condition, those who begin to notice changes in their swallowing function should seek the support of a Speech Pathologist as soon as possible. When swallowing becomes more difficult, individuals may notice that they feel food and drinks going ‘down the wrong way’, or others may notice that their mealtime behaviour has changed. An increase in coughing or even a reduction in how much or how often someone is eating can be a sign that swallowing difficulties are present.
Other signs and symptoms of dysphagia include:
- Choking when eating or drinking
- Clearing the throat
- Slow mastication (chewing)
- Difficulty swallowing dry or chewy foods
- Food being left inside or around the mouth
- Gurgly or wet voice after swallowing
- Drooling or inability to control saliva
- Pain when swallowing or a fear of eating
- Sensation of food or medications getting “stuck” in the throat or neck region
- Difficulty triggering or initiating a swallow
- Unexplained weight loss
- Recurring chest infections
- Pneumonia
- Taking a long time to eat or become fatigued during or after a meal
Research confirms that people with Parkinson’s Disease are more at risk of ‘silent aspiration’ – a term used to describe when food or drink goes ‘down the wrong way’ (into the airway) and a cough is not initiated to get it out. This is concerning because when too much food or drink goes down the airway, an individual is more at risk of choking and developing aspiration pneumonia. This is why it is so important to get a thorough swallow assessment completed as soon as you notice changes in swallowing function.
Aspiration and Parkinson’s Disease
To determine whether someone with Parkinson’s Disease is aspirating on food and drinks, it is important to combine a clinical swallow assessment with an instrumental assessment – this is a type of test that involves using equipment to look at what is going on inside the throat when swallowing. The two golden standards of instrumental assessment are Videofluoroscopic Swallowing Studies (VFSS) and a Flexible Endoscopic Evaluation of Swallowing (FEES). At Speak and Swallow, our go-to instrumental assessment is a Flexible Endoscopic Evaluation of Swallowing (FEES) as we are able to conduct this on site at our clinic. You can learn about this instrumental assessment here.
Researchers have shown that through the use of FEES instrumental assessments, instances of silent aspiration and audible aspiration (where coughing is initiated) can be identified, recorded, and used to inform dysphagia management and therapy planning. Given that dysphagia and events of silent and audible aspiration are frequently seen early in Parkinson’s Disease progression, it is important to consider early evaluation and therapy intervention for all individuals diagnosed with Parkinson’s Disease or are presenting with Parkinsonism type symptoms.
Parkinson’s Disease Swallowing Difficulties and Quality of Life
Eating and drinking are central to much of our lives – it goes beyond our daily nutritional needs – feeding into how we socialise and enjoy time spent with others (think: going out for dinner with friends, enjoying birthday cake). For this reason, it is well known that swallowing difficulties can have a big impact on individuals with Parkinson’s Disease. Some individuals note changes to their eating habits and stress around adjusting to social situations involving eating and drinking. A significant impact to quality of life is also not necessarily correlated with dysphagia severity – meaning that even slight changes in swallowing function can have a large impact on someone’s self-reported quality of life.
At Speak and Swallow Speech Therapy, we know how important it is to balance mealtime safety with enjoyment and autonomy. It is possible to maintain the joy of eating and drinking while addressing swallowing safety with compensatory strategies and dysphagia rehabilitation. Condition progression is also an important factor with Parkinson’s Disease, as swallowing function will deteriorate over time. Rehabilitation strategies can help to maintain swallowing function, however it is also important that people with Parkinson’s Disease and their family build strong relationships with a trusted Speech Pathologist to help guide condition management and keep an eye on any changes that may occur over time.