Share this post: ×

Persons with Parkinson’s Disease and Dysphagia

 

By: Mary Spremulli, CCC-SLP. Ms. Spremulli is the owner of Voice Aerobics, LLC, a Speech-Language Pathology Private Practice, located in SW Florida. She holds a speech-language pathology license in Florida, Ohio, and North Carolina, and a nursing license in Florida. She is a faculty member of Parkinson Place in Sarasota, FL, and a member of the Education Committee of the World Parkinson Program. Ms. Spremulli has been a Clinical Consultant with Passy-Muir, Inc. for over 20 years providing education to professionals and patients, and she has published articles on the topic of patient education. Since 2013, Ms. Spremulli has hosted a monthly podcast, focusing on topics related to living well with Parkinson’s and other neurological diseases.


80% of Persons with Parkinson’s Disease Develop Dysphagia, yet less than 10% report symptoms

 

Less Than 10% of persons with Parkinson’s disease (PD) report symptoms of a swallowing problem, yet more than 80% of persons with PD develop dysphagia (swallowing impairment) over the course of the disease, in particular in the advanced stages when they may also be dependent on others for  physical care.[i]

In a recent review article, Dysphagia in Parkinson’s Disease, authors, Inga Suttrup and Tobias Warnecke, discuss the scope of the problem and the importance of early screening for dysphagia by neurologists. It has been shown that dopaminergic and nondopaminergic mechanisms are involved in the development of dysphagia which may affect any or all stages of swallowing, oral, pharyngeal or esophageal.

In the early stages of dysphagia, patients may compensate for subtle changes in swallowing, and the usual non-motor and motor questionnaires, such as the UPDRS (Unified Parkinson’s Disease Rating Scale) used by neurologists and others, contain only one question about swallowing function, making them insufficient for assessing the presence or scope of the problem. A patient’s report of symptoms, such as: food “sticking”, coughing when drinking and eating, or difficulty taking pills, unexplained weight loss, history of pneumonia or other pulmonary disease, and drooling should all be red flags suggesting the possibility of dysphagia. Additional motor symptoms which I have witnessed in my own practice as possibly contributing to dysphagia, include oral-mandibular dyskinesia and   dyskinesia affecting the respiratory muscles contributing to poor timing and coordination between breathing and swallowing with resultant risk for aspiration.

Since no specific screening tool currently exists to identify dysphagia in persons with Parkinson’s disease, patients exhibiting any of the symptoms mentioned above should be referred to a speech-language pathologist for a clinical and instrumental swallowing assessment. An instrumental swallowing assessment, allows for visualization of the structures involved in swallowing, and these assessment tools are helpful in determining safety and efficiency of swallowing function as well as identifying what additional compensatory strategies or specific swallowing exercises may be of benefit. Patients who report difficulty with taking their pills, and who point to their throat or chest, saying: “they get stuck here,” may have pills getting lodged near the base of the tongue and epiglottis, or stalled in the esophagus, causing mucosal irritation and resulting in poor absorption of the medication.

Like most things with Parkinson’s disease, there is rarely a one size fits all, therefore, it’s important that persons with Parkinson’s be educated about the signs and symptoms of dysphagia, and when necessary, keep track of fluctuations in swallowing, drooling, and speech production, that might be related to medications or disease progression.

Referral to a speech-language pathologist for an instrumental swallowing assessment sooner rather than later can help to obtain important baseline information and help in developing some proactive strategies that may delay onset of serious problems such as aspiration pneumonia.

Follow podcast: http://www.blogtalkradio.com/voice-aerobics

[i] REVIEW ARTICLE Dysphagia in Parkinson’s Disease Inga  Suttrup and Tobias Warnecke. Dysphagia

DOI 10.1007/s00455-015-9671-9 2015.

*******************************************************************************

If you are interested in learning more about dysphagia,  join Mary Spremulli for Voice Aerobics Talking 2 You, podcast in January. She will be talking about dysphagia, including DBS effect on swallowing in Parkinson’s disease. Guests include: Luis F. Riquelme, Ph.D., CCC-SLP, BRS-S Associate Professor, Speech-Language Pathology, New York Medical College, and Ed Steger, President, National Foundation of Swallowing Disorders.

Follow podcast: http://www.blogtalkradio.com/voice-aerobics



Leave a Reply

Your email address will not be published. Required fields are marked *