14 Facts About Parkinson’s Disease and Dysphagia
As a neurological disorder, Parkinson’s disease (PD) has been shown to affect motor skills in the limbs, inhibit muscle coordination, and sometimes contribute to dysphagia.1 Because lack of awareness of swallowing difficulty, as well as silent aspiration, are not uncommon in PD, it is critical to monitor weight and provide counseling regarding signs and symptoms of swallowing difficulty even to individuals who report no swallowing difficulties.2
Below are 14 facts to be aware of concerning dysphagia in relation to PD patients.
- Dysphagia affects approximately 33% of all patients diagnosed with Parkinson’s disease,3 although other prevalent studies highlight dysphagic effects noticeable in a broad range of PD patients from 45% to 90%.4
- Early identification of swallowing abnormalities is critical in helping to minimize the negative impact on dysphagic patients and to improve quality of life and ongoing health status.5
- Dysphagic complications can manifest themselves in the forms of aspiration pneumonia, malnutrition and dehydration.6
- In some cases, PD patients may be unaware of the presence of dysphagia, even when weight loss, dehydration and pneumonia are present.7
- Patients affected by PD should be aware of and closely monitor any increased coughing episodes or a negative alteration of voice quality as these may be early symptoms of dysphagia.8
- Repetitive backward and forward rocking motion of the tongue termed “tongue pumping” has been widely observed in PD, and is considered to be an early indicator of the presence of the abnormality.9
- There is no proven correlation between the severity of dysphagia in PD patients as compared to the overall severity of the disease.10
- Up to 55% of PD patients report xerostomia or dry mouth, which can enhance negative dysphagic effects.11
- When PD patients are unable to feed themselves, it is critical that caretakers observe and practice techniques that promote the safety of each swallow through smaller portions and longer meal times.12
- While eating modifications may be necessary for safety precautions related to dysphagic PD patients, it is imperative not to reduce liquid intake as this may result in dehydration and digestion issues.13
- Compensatory strategies for PD patients help to control food flow and minimize dysphagic symptoms without altering swallow physiology. An example of this – and one technique – is the “chin tuck method” in which the patient tucks the chin to the chest with the head tilted at an approximate 45-degree angle when swallowing.14
- Therapeutic strategies are designed to moderately or completely alter swallowing physiology and include active range-of-motion exercises for the tongue and lips and also include falsetto exercises to facilitate laryngeal elevation.15
- In many instances, a balanced application of compensatory and therapeutic strategies as supervised by a SLP or physician, and a diet of thickened foods and beverages, which may be supervised by a dietician, may collectively decrease dysphagic effects and promote positive swallowing and effective digestion.16
- For patients with documented swallowing difficulties, regular evaluation should help to anticipate problems and put strategies in place to reduce the likelihood of malnutrition, dehydration, and pulmonary problems.17
Neurological disorders, inclusive of Parkinson’s disease, strokes and other neurological maladies will likely continue to be leading causes of dysphagia.18 However, understanding the signs and symptoms of dysphagic disorders will provide insight related to the successful treatment of this swallowing malady in PD patients.19
- Murray T, Carrau RL. Clinical Management of Swallowing Disorders. 2. San Diego, CA: Plural Publishing; 2006.
- Spencer KA, Yorkston KM, Duffy JR. Behavioral management of respiratory/phonatory dysfunction from dysarthria: A flowchart for guidance in clinical decision making. J Med Speech-Lang Pathol. 2003;11(2):39–61.
- Yorkston KM, Spencer KA, Duffy JR. Behavioral management of respiratory/phonatory dysfunction from dysarthria: A systematic review of evidence. J Med Speech-Lang Pathol. 2003;11:13–38.Ibid.
- Bunton K, Kent RD, Kent JF, Duffy JR. The effects of flattening fundamental frequency contours on sentence intelligibility in speakers with dysarthria. Clinical Linguistics & Phonetics. 2001;15(3):181–193.
- Yunusova Y, Weismer G, Kent RD, Rusche N. Breath-Group Intelligibility in Dysarthria: Characteristics and Underlying Correlates. J Speech Lang Hear Res. 2005;48:294–1310.
- Turner GS, Tjaden K, Weismer G. The influence of speaking rate on vowel space and speech intelligibility for individuals with amyotrophic lateral sclerosis. J Speech Hear Res. 1995;38:1001–1013.
- Bellaire K, Yorkston KM, Beukelman DR. Modification of breath patterning to increase naturalness of a mildly dysarthric speaker. Journal of Communication Disorders. 1986;19:271–280.
- Beukelman DR, Fager S, Hanson CUE, Logemann J. The impact of speech supplementation and clear speech on the intelligibility and speaking rate of people with traumatic brain injury. J Med Speech-Lang Pathol. 2002;10(4):237–242.
- Garcia JM, Dagenais PA, Cannito MP. Intelligibility and acoustic differences in dysarthric speech related to use of natural gestures. In: Cannito MP, Yorkston KM, Beukelman DR, editors. Neuromotor Speech Disorders: Nature, Assessment, and management. Baltimore: Brookes Publishing; 1998.