Difficulty Swallowing (Dysphagia) in Parkinson’s Disease Patients

Parkinson’s disease is a chronic neurodegenerative disorder occurring in the elderly patients characterized by the loss of dopaminergic neurons in the part of brain called as nigrostriatum. Dopamine is predominantly involved in the  muscular control and coordination of the body. 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. It affects about 40% to 90% patients of the Parkinson’s disease.

Swallowing difficulties can occur at any stage of Parkinson’s disease. 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. Aspiration pneumonia is the leading cause of death in Parkinson’s disease.

How does dysphagia occur?

Dysphagia is defined as inefficient or unsafe transfer of the food, liquid or saliva from the mouth into the stomach

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.

  • Oral stage deficits occur most frequently in the parkinson’s disease patients and are mostly the first indication of dysphagia. Due to the limited excursion of the mandible, there is an increase in the time for oral preparation and chewing. Also, the “tongue pumping”, which is a repetitive backward and forward rocking motion of the tongue, prevents the food material to leave the oral cavity. Along with that, the 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.


  • Pharyngeal stage deficits: Occur due to the delay in triggering of the pharyngeal swallow. However, the delay is usually mild, still, any delay in triggering the pharyngeal swallow, usually carries the risk of aspiration. Cognitive impairment, upper extremity impairment, and impulsive feeding behavior exhibited by the patients with advanced Parkinson’s,  contribute to the exacerbation of oropharyngeal dysphagia.


Signs and symptoms

Dysphagia in Parkinson’s disease is associated with increased morbidity and mortality. Signs and symptoms can range from mild to severe and include:

  • Presence of food particle residues in the oral cavity, long after swallowing.
  • Difficulty in swallowing drinks and food.
  • Frequent coughing during and after eating or drinking, with a feeling as if something is stuck in the throat.
  • Abnormal bolus formation, multiple tongue elevations, delayed swallowing reflex, increased time taken by the food bolus to pass through the pharynx.
  • Drooling of saliva
  • With the advancement of disease, swallowing might get severely compromised and can lead to aspiration.

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. A physical examination of head and neck is usually done along with trials with the food/liquid. A modified water test to assess the maximum swallowing volume is recommended to diagnose the oropharyngeal dysphagia.

If indicated, certain tests may also be done. These instrumental methods allow a reliable detection of aspiration events.

  1. Video-fluoroscopy: It is an instrumental examination with a moving X-ray. It is also commonly known as modified barium swallow study.
  2. Endoscopy: The throat is visualized with the help of an endoscope.
  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.
  • dehydration
  • Shorter survival time in a patient with Parkinson’s disease.
  • Dysphagia also complicates the medicine intake, which further complicates the situation.
  • 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. Overall, it reduces the quality of life.

Treatment of dysphagia in Parkinson’s Disease

It is crucial to monitor the weight and provide necessary counseling about the signs and symptoms of swallowing difficulties, even to the patients who have not reported any swallowing difficulties as yet. Evaluation and treatment of swallowing disorders are done by a speech language pathologist.

  • Behavioral treatments for dysphagia remain the mainstay of management as the pharmacological and surgical options for Parkinson’s disease are known to have more positive effects on the motor symptoms as compared to the non motor symptoms related to swallowing.
  • Intensive swallowing therapy by a speech-language pathologist can help to overcome the weakness in the swallowing apparatus by strengthening exercises or compensatory maneuvers. Swallowing hard, holding breath while swallowing, tucking the chin to chest while swallowing are some compensatory maneuvers to help easy feeding.
  • 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.
  • A fluctuating dysphagia during the ‘off-phase’ must be managed by optimizing dopaminergic medication.
  • Gastric feeding tube in end stages of the disease may become necessary.
  • Feeders who feed the patients, must be trained to monitor the safety of each swallow, and smaller bites at a slower rate must be encouraged.
  • A percutaneous enteral gastrotomy is done for the enteral feeding, which improves the quality of life by providing nutritional support.



  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. 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….

  3. 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,

  4. 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?

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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?

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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!

  16. I don’t have a comment just a question, my dad is old and has agent orange, high blood pressure, diabetic, over weight, cant walk and yesterday had uncontrolled bleeding in his nose. Today the doctors said that he might have aspiration pneumonia, dysphagia where cant swallow his food. I know he is in the advanced stages, but my question is how much longer does my dad have? My wife has had some Parkinson’s training working for the VA, and she told me that my dad probably doesn’t have much longer, that’s why I’m asking.

  17. Did the choking/coughing and throat constriction start overnight? My uncle has lived with me for 4+ years right after his diagnosis. We believe he was in mid stages for three years prior to my taking over his care. He woke up four days ago and can barely talk, he chokes and starts coughing when he drinks anything but he’s eating ok. He can barely cough let alone cough up any phlegm Very very hoarse and we can barely hear/understand him. Literally overnight. Any thoughts?

  18. My husband had an aspiration pneumonia incident on Easter — he went to the hospital re ambulance and is still there; he has difficulty swallowing and I don’t know if a PEG should be done or not. i am afraid he will pull out the tubes. Does anyone have any suggestions.?

  19. I do not have Parkinson’s Disease but I have parkinson’s symptoms. I have Multiple System Atrophy (one of the most 100 rarest diseases)….which in effect means that the organs in my body which work involuntarily will eventually fail. I already have a pacemaker due to this disease. I have been having difficulty for a while with choking and food getting stuck in my upper chest. I just had a swallow test and was told I have severe oral dysphagia. The doctor told me to start to think about having a feeding tube and said that within a year or less I will need one. For now, he has told me to use nectar thick for everything I eat with the exception of a few things like pudding and yogurt. I am so afraid and for the first time since my illness was diagnosed, I feel sorry for myself. I know that is wrong but I can’t help it. I have ordered the nectar thick and will try it. One of my biggest concerns is the cost. I have contacted Medicare and they do not cover it, I live on a fixed income…Social Security….and am not sure I can afford the nectar thick. I would like to hear from anyone who has a feeding tube to tell me what it is like having one.

  20. I was diagnosed with Parkinson’s disease in my mid to late 40’s. I had hand tremors for several years. Gradually became worse. I then noticed when I was tired the tremors were worse. I started falling for no apparent reason. I now have stiffness in my legs and need to walk with 2 canes or a walker. I am very slow getting around. I am now 52 years old. I am forgetful at times and have difficulty expressing myself. I have difficulty swallowing at times. I become tired easily, I also become quite dizzy when performing any athletic function (jogging). I was on Levodopa/Carbidopa, 100/25. nothing was really working to help my condition. Finally i started on parkinson’s natural herbal formula i ordered from MED LAB TEC, i read alot of great reviews from other patients who used the parkinson’s herbal treatment. My symptoms totally declined over a 4-5 weeks use of the Health herbal clinic Parkinsons disease natural herbal formula. , its effects on parkinson’s is amazing, all My symptoms gradually faded away, I have been active and hope to continue! or email at ere unbelievably reversed, herbs are truly gift from God. contact this herbal clinic via their email;medlabtec(AT)mail(DOT)com) I recommend this Parkinson’s herbal formula for all Parkinson’s Patients. and other similar sickness HPB,ALS Hepatitis Virus etc ;never stop trying .

  21. My husband was diagnosed with PD in January 1999 and then two years ago with Dementia. He had the DBS surgery in 2003 which helped him with the symptoms. During the last two years, it was difficult to hear what he was saying. He was in the advanced stage of the disease. On Wednesday, he ate all his meals and on Thursday, he couldn’t swallow. Has anyone every heard of a Parkinson’s patient eating one day and the next day cannot swallow? My husband passed away on March 25, 2017 and I miss him very much. Tears come and go but I can’t have him back.

  22. I have just started caring for my father In Law… He moved in this week as his Parkinsons has now become unmanageable at home for his lady friend. I came here looking for foods that would be easier for him to eat as he has trouble swallowing. I would just like to thank you all for sharing your stories as I do all I can to help my father In law in these advanced stages.

  23. My husband passed away on 3/25/2017 at the age of 70, two weeks after his birthday. He had Parkinson’s for 17 years and Dementia for two years. He had three meals on Wednesday and Thursday morning he couldn’t swallow. He never had swallowing problems prior to Thursday morning. Has this happened with any of your loved ones? He was admitted to the hospital and was there for four days and discharged. I brought him home but he couldn’t swallow anything. He was home with me for seven days and slipped away from me on the 7th day. I cry almost every day and the grief seem to be getting worse. I have a Panama Amazon parrot who talks to me and I exercise three times a week. We were married for 30 years and it is so hard to live without Larry after being with him for so long. I go to his crypt and cry and talk to him knowing I won’t get a response from him but I still do. I miss him so much.

  24. I noticed nothing different about my walk. It was difficult getting up from` a chair and getting out of a car. I was diagnosed a year later and i have to find a better solution and was introduced to try the help of herbal formula. I am now 59 tho and am fully cured from Parkinson’s disease.
    contact Total Cure Herbal Foundation on: Totalcureherbalfoundation@ gmailcom i had to use the remedies for 15 weeks usage which really help on my condition.

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