Difficulty Swallowing (Dysphagia) in Parkinson’s Disease Patients

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. Refer to Parkinson’s Disease Drugs.
  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. Video-fluoroscopy.
  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.

17 Comments

  1. From what I’ve read here I can tell my mother is in late stage Parkinson’s. She has a feeding tube but still likes to (says she needs to) take some liquid by mouth. She stays with thicker liquids. My concern and the reason I’m here is she has been having frequent choking spells. Of course, they scare her and the rest of us too. She’s had the swallow study and various exercises to do. She’s not very co operative about the exercises any more saying they don’t help anyway (which she says via a dry erase board because we are no longer able to understande 99 percent of what she says orally. She’s 89 years old, her mind sharp, her attitude and appreciation of life great. She has told us if she chokes and her heart stops, no resusitation. Does anyone have a suggestion as to how to help her, what to do for her and what she might still be able to do for herself. We realize it’s end stage but we’re not ready to give up. Hope is important. Is there surgery or anything to keep her throat clear and her comfortable?

  2. My mom has exactly similar problem as described above. Please

    help.

    A v i j i t

  3. June:
    On January 1, 2011, my mother, afflicted with Parkinson’s, choked to the point where she was unconsious and not breathing. If not for the efforts of my brother recusitation attempts until the arrival of EMS, she certainly would have died. She was on a ventilator for 5 days, as she aspirated into her lungs, which is now cleared up. My father is in denial in that he feels that he can be her primary caregiver, and can look after her. We, the siblings say no more. She now requires, at minimum, 12 hour a day, 7 days per week care by a professional. My father goes out during the day for an hour or so at a time, and he is no sooner out of the driveway and my mother is trying her best to get her walker and into the kitchen, where 90% of the time, she has fallen and unable to get up and will lay there for the duration until he arrives home.
    This is no longer acceptable, and these recent choking episodes, known as dysphagia, are only going to increase, as she will not stick to the plan and program set out for her.
    All I can say,if your mother is as stubborn as mine, a close watch will have to put on her…and please take a CPR course and learn the proper Heimlich technique for persons afflicted with this horrible disease.
    In answer to your questions, there is only swallowing exercises that an SLP can provide, and you should consider her wishes not to be revived in the event of a incident. I am convinced that my mom is of the same desire…tragic, but true.
    All the best, and stay in touch on the site..I will keep you posted if you wish….
    Bob

  4. I would suggest asking your family physician about a speech-langugage pathology evaluation for determination of swallowing safety and guidance to help your family members stay safe as possible

    • My father is past anyone helping him as far as Speech therapy ect. He has started choking and coughing on puree food so I’ve given him a small spoon. I believe the Parkinson’s has now affected his brain
      because for about 3 weeks now he has gone back 30yrs in time and is up at all hours trying to tell me what he just remembered and It doesn’t matter if I’m sleeping he will wake me up and I have become so physically exhausted, never mind my mental state of stress. His doctor says next step will be to hospitalize him and tube feed him and that unfortunately because he has DNR request he will probably only survive a few weeks. To all you siblings that are looking after your parents my prayers and thoughts are with you. I have had my dad for 12 years and the past 3 years have gotten more and more difficult. But I have never had the heart to put him in a home but at the same time it has not been an easy life for me and my husband who by the way has been amazing with my father. I don’t think there are any easy answers for our parents and I find the medical field is less helpful as they age and know there is really nothing they can do for them but right another script. All I know is I will be with my dad to the end which I feel will be soon, and just love him and keep him as comfortable as possible. I feel that’s the best any of us can do. And I will have peace that he left us knowing we loved and cared for him. (Now that he has what they call Parkinson’s demensia I think it’s harder for him to remember to swallow properly,

  5. My Mum is 89 and has had a carer 24/7 for past three years she is unable to move dress or eat without assistance. Communication is minimal probably just yes and no. This last week choking and gagging has increased to a point where we seeked more guidance from doctor. His advise is to admit my mother over next few days into hospital, to put her on a feeding tube as when she now eats food is going down wrong hole and leaving her malnurished. After this she is due home and probably to be fed by feeding tube?
    Has anyone any advise on how to help mum and also roughly how long they think mum might have left, not sure whether we’re talking days weeks or months?
    Wendy

  6. It’s so sad. My Dad died on June 5, 2011 from aspiration pneumonia associated with Parkinson’s Disease. He had a gastric tube and was in a nursing home. One morning he started to choke and was transferred to the hospital where he died 3 days later.

  7. Hi everyone,
    I am a speech pathology student in my final year studying in Australia. I found it interesting reading your stories and can only imagine of the pressures you live with daily. If you know someone with P.D. that has difficulty swallowing, ensure you get them assessed by a speech pathologist asap. The risk of aspiration is far too serious to leave. THere are also dietary modifications and particular techniques to use when swallowing to assist the person to swallow without the risk of aspiration. Communication devices can also be designed so that the person can effectively communicate with others.

  8. My mother has front lobal dementia as well as Parkinsons and is finding it increasingly difficult to swallow. She is totally reliant on her carers (my brother and niece)and she can no longer communicate at all. What would anyone suggest is the easiest way to prevent her choking on the now pureed food she has going to the lungs instead of the stomach. She is now given liquids via a syringe. Her doctor seems to think that they are doing the best that they can but offers no other suggestions.

  9. My Father is suffering from parkinson since last 4 years and condition is worsening day by day. But recently i have started physiotherapy and it really works. Physiotherapist also provides speech therapy and his ability to speak has oncrased a lot. His tendency towards chocking during eating also has reduced. Last 2-3 months he is doing it on regualr basis. I am hoping and praying to recover more.

  10. My brother has young onset P.D., it was 11 years ago that he was diagnosed he is now 59, and is in ending stage, he can no longer do anything by himself, and is now in a nursing home. He is stating to choke and aspirate all the time, he is now on hospice care, we have elected to not use a feeding tube, since it would only prolong his ongoing suffering, and is something he said he never wanted (when he could communicate) and aspiration can still occur with the tube. Does anyone have any other suggestions?

  11. My father-in-law lived with me for 8 years and had Parkinson’s. He died last year at the age of 92. We fed him by mouth and adjusted the consistency of the food we gave him so he never was tube fed. It took about an hour to feed him each meal. Keeping his head upright and straight, giving him small amounts on each spoon and reminding him to swallow with each spoonful helped. Also, he could not drink water, so we made frozen soft sorbets using frozen fruits (without seeds like banana, peaches, mango) and yogurt which seemed to make it easier for him. As his Parkinsons progressed, we found we had to adjust the consistency of the foods to make it easier for him to swallow properly without any need to chew.

  12. Aspiration pneumonia can still occur with a PEG tube. An SLP can assess the swallow and recommend postural changes and dietary modifications such as a softer texture to lessen the risk of choking. There are no surgical interventions for purpose of swallowing in PD. smaller portion size and strategies for careful eating may also be recommended by your SLP.

  13. My heart and prayers go out to all of you. My mom had PD for 10 or so years and died in 97 of a heart attack, so the coroners report read. I was only 25 and she only 63. I am a RDH who is giving her first talk to a PD support group looking for oral health answers.

  14. my husband has advanncing PD and the doctors are recommending a peg tube because he is having aspirated pneumonia. The things I have read seem to suggest that this does not really help those with PD as much as perhaps some other illnesses. Also, the dry mouth, chance to aspirate on saliva, etc., just seems to make the decision even more difficult.

  15. My husband has had PD for 5years .He was getting aspirated pneumonia every 6 weeks we were advised to put in a feeding tube .He has 6 feeds a day nil by mouth (SLP) how can he still get aspirated pneumonia .we live in QLD AUSTRALIA

  16. My wife was diagnosed at age 34, thanks to the excellent care provided by University Neurologists of Rush University in Chicago she still leads a fairly normal and productive life. She drives on occasion and works hard at maintaining herself, she worked up to age 55, 21 years after being diagnosed!

    Thank you Dr. Klawans, (deceased), Dr. Shannon, Dr. Penn, Dr. Verheagen and Dr. Bakay. (The doctor that developed and performed the Deep Brain Stimulation. Not to mention the supporting staff of nurses.

    Thank you very much!

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