About Parkinson's Disease




Swallowing and Parkinson's Disease


 

It is a common occurrence for PwP to present with some form of swallowing difficulties at some point in the progression of the condition. It is very important to recognise and manage the symptoms so that the PwP can continue to enjoy eating and drinking safely for as long as possible.  Dysphagia (swallowing difficulties) is thought to be the main cause of aspiration pneumonia (food or drink entering the lungs) and death in PwP (Ebihara et al., 2003; Kakashima et al., 1997) and therefore once again we see the importance of correct management. The Speech & Language Pathologist (SLP) is the professional responsible for treatment of swallowing problems in PwP.

 

One of the earliest signs reported is difficulty swallowing pills. Patients frequently report pills sticking at a point they identify as high in the neck, throat or chest. However there is a range of symptoms of both swallowing and eating abnormalities that are important to look out for and these are listed below.

 

Symptoms include the following:  (Rosenbek & Jones, 2009)

 

  1. coughing or choking on food and liquid
  2. excess saliva, due to the reduced number of saliva swallows
  3. choking or coughing on saliva
  4. drooling
  5. food falling from mouth
  6. food and liquid sticking in mouth or throat
  7. thick mucus
  8. difficulty chewing
  9. impaired taste and smell
  10. loss of appetite
  11. weight loss
  12. increased length of time required for meals

 

Functional/Quality of Life influences

 

  1. slowness of eating, requiring increased length of time for meals
  2. messy eating for a variety of reasons
  3. reluctance to eat in public also for a variety of reasons
  4. embarrassment about drooling of saliva, food, and drink
  5. fear of choking
  6. having to leave the table to try to dislodge food at the sink

 

Health consequences

 

  1. aspiration pneumonia (chest infections due to food or drink entering the lungs)
  2. weight loss
  3. dehydration
  4. anorexia
  5. disturbed sleep

 

For maximum effect, the management of PwP should be team treatment.  Swallowing is likely to be influenced by the timing and effect of medical/surgical treatments and by the physical, psychological, and intellectual consequences of PD as it advances.  Therefore, decisions about swallowing procedures must be integrated into a total plan of care. 

 

The importance of the SLP in swallow management cannot be exaggerated, as aspiration can lead to the person becoming very ill. Treatment decisions will be influenced by the duration of illness as well. Side effects such as dyskinesia (uncontrolled repetitive movements) in tongue and lip muscles from prolonged PD medical treatment do occur, and swallowing abilities may decline. 

 

 The SLP can recommend both compensatory as well as rehabilitation strategies, the safest, least invasive diet consistency, bolus size, eating rate, order of liquid and solid boluses, posture, and eating environment.  In PwP, thicker consistencies generally result in less penetration and aspiration than thinner consistencies (Troche et al, 2008).  However, although dietary modifications may be necessary at times, such a decision should not be entered into lightly, and rehabilitation should always be considered. 

 

Acknowledgement:

 

Alexandra Ameen Snr Speech Language Pathologist, Dysphagia Specialist

 

References:

 

  • Parkinson’s Disease Society
  • Rosenbek & Jones (2009). Dysphagia in Movement Disorders, Plural Publishing, San Diego, CA
  • Ebihara et al (2003) Impaired efficacy of cough in patients with Parkinson’s Disease. Chest, 124(3), 1009 – 1015
  • Trouche et al (2010). Aspiration and swallowing in Parkinson’s Disease and rehabilitation with EMST: A randomized trial. Neurology, 75, 1912-1919
  • Images courtesy of dream designs and imagerymajestic at FreeDigitalPhotos.net


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