Dysphagia means essentially difficulty in swallowing and is a fairly common symptom in Parkinson’s disease. Patients report dysphagia anywhere from 30% to over 80% of the time depending on the survey. When you consider studies that actually objectively look for dysphagia through imaging techniques, this number can approach almost 97% whether or not the patient is even aware of it. So essentially this is a significant problem.
Difficulty swallowing in Parkinson’s may be due to a variety of reasons. Normal swallowing is complex and requires coordinated movement of the tongue and other muscles in the mouth to chew and form a food “ball” or bolus which is then moved by the muscles in the upper throat or pharynx to the esophagus and onwards to the stomach. In Parkinson’s disease, when these muscles don’t function normally, swallowing becomes more difficult.
This is a serious matter, particularly late in the disease. According to the National Institute of Health, the leading cause of death in Parkinson’s disease is aspiration pneumonia. This occurs when the muscles responsible for protecting our airways and keeping the food on its journey to our stomachs, don’t work as they are supposed to leaving us vulnerable to aspiration. With aspiration, food actually enters our windpipes and lungs causing inflammation and infection. Other serious health issues resulting from dysphagia include choking, malnutrition and dehydration.
Signs of dysphagia that you need to be aware of include drooling (decreased swallowing leads to a build up of saliva in the mouth), coughing or choking during meals, a sensation of something being stuck in your throat, a change in your voice, unintended weight loss, sore throat and heartburn.
If you have any of these symptoms, you must report them to your neurologist or movement disorder specialist as soon as possible so that they can help manage this potentially dangerous symptom. The standard initial investigation into dysphagia is the modified barium swallow where the actual process of swallowing can be seen. The patient drinks a liquid containing barium and then an x-ray machine records how they swallow thereby showing where the problem is occurring. There are other potential tests including endoscopy where a specialist looks at your esophagus with a scope.
Once diagnosed your physician may try changing the type or dosing of your PD medications, ensuring that they are at their maximal effectiveness at mealtimes. Referral to a speech-language pathologist for a swallowing evaluation and treatment may also be appropriate. These health professionals may be able to help improve swallowing through a number of conditioning techniques that include specific exercises to increase muscle strength and range of motion. One such technique called effortful swallow involves the patient squeezing hard with their muscles when they swallow. Another technique to help protect the airway is double swallowing followed by a cough. The more formal Lee Silverstein Voice Treatment (LSVT) program is also useful in helping swallowing abnormalities as well as voice.
Also since the consistency of food influences how it is swallowed, a referral to a nutritionist or dietician may be necessary as well. Depending on which foods are the most problematic,different levels of diet may be recommended. Suggested diet changes may be quite restrictive where foods need to be pureed to liquid consistency or may be less so allowing any soft foods while avoiding hard things like nuts, raw vegetables etc. and stringy foods. A dietician along with your physician can recommend what is most suitable for you. In more advanced disease, a surgically placed feeding tube into the stomach may be needed to maintain hydration and nutrition.
The following are some general suggestions that may help with dysphagia:
- In between and prior to meals, suck on ice chips or drink small but frequent sips of water to thin saliva or phlegm build up which will help with swallowing.
- Always take small bites of food and chew food thoroughly.
- Do not rush.
- Make sure all food is cleared from your mouth before you take your next bite.
- Wash down solid foods with liquids.
- For 15 to 20 minutes after a meal, sit upright.
- Try to avoid tilting your head backwards when eating or drinking. Instead sit upright and place your head slightly forward.
- Sleep with your head elevated to avoid choking.
Swallowing, which we take for granted may provide a significant challenge to those of us with Parkinson’s disease as our illness progresses. Given that aspiration pneumonia is a leading cause of death, every effort must be made to prevent or reduce the consequences of this symptom.