Quick Facts:

• Swallowing difficulty can occur at any stage of Parkinson disease (PD), even the early stages
• The leading cause of death in PD is aspiration pneumonia due to swallowing disorders.
• Evaluation and treatment of swallowing disorders are performed by a speech language pathologist
• Swallowing disorders are treatable

Difficulty swallowing, or dysphagia, can happen at any stage of Parkinson disease and can be localized to the mouth, throat, and esophagus. Signs and symptoms can range from mild to severe and may include:

• Drooling
• Difficulty swallowing certain foods or liquids
• Coughing or throat clearing during or after eating/drinking
• Needing to swallowing multiple times per bite or sip
• Feeling as if food is getting stuck
• Frequent heartburn/reflux

As the disease progresses, swallowing can become severely compromised and food/liquid can get into the lungs, causing aspiration pneumonia. Aspiration pneumonia is the leading cause of death in Parkinson’s. There is also a risk for severe choking, when food lodges in the airway and prevents the ability to breathe.

It is important to take note of any changes to swallowing function, because there is opportunity to intervene early and preserve both health and quality of life. Swallowing disorders are managed by the medical team with a speech-language pathologist and physician. Evaluation typically involves an interview, a physical examination of the head and neck, trials with food/liquid and if indicated, an instrumented examination, either with a moving x-ray, called videofluoroscopy (also known as a modified barium swallow study) or by visualizing the throat with a scope (called endoscopy). New technologies are being developed that may be able to detect Parkinson’s-related changes to swallowing function even before someone begins to notice swallowing difficulty. One example is high-resolution manometry, a technique that measures pressures generated in the throat during swallowing (see figure below).

Treatment of swallowing disorders is specific to the nature of the swallowing problem, but can involve strategies to help food or liquid go down safely (swallowing hard, holding your breath while swallowing, tucking the chin while swallowing), diet changes (thickening liquids, making foods softer), exercises, or a combination of these. In some cases, alternatives to oral feeding, such as a feeding tube, are indicated. However, just because you have a swallowing problem, it does not mean that you will need a feeding tube.

Because Parkinson disease is progressive, swallowing abilities can change over time, underscoring the need for early intervention and frequent follow-up. It may be beneficial for you and your healthcare team to have a “baseline” swallowing study as a comparison for later in the disease progression. Sometimes the signs of a swallowing disorder can be subtle, so it is important to be vigilant. Below are some signs that you may have a swallowing problem:

• You have recently lost weight without trying
• You tend to avoid drinking liquids
• You have heartburn or a sore throat
• You tend to drool
• You get the sensation of food stuck in your throat
• You cough, choke, or clear your throat during or after meals
• You have trouble keeping food or liquid in your mouth
• You have trouble moving food to the back of your mouth
• You have difficulty swallowing pills
• You have lost your appetite
• It takes you a long time to eat a meal
• Sometimes you have a fever for no apparent reason

If you think you have difficulty swallowing, ask your physician to refer you to a speech-language pathologist for a swallowing evaluation.  

References and Resources:

• National Foundation of Swallowing Disorders
• American Speech-Language Hearing Association Dysphagia Information Page
• NIH Swallowing Disorders Information Page

• Beyer, et al. Causes of death in a community-based study of Parkinson’s disease. Acta Neurol Scand. 2001;103(1):7-11. PubMed link
• Ciucci, et al. Early identification and treatment of communication and swallowing deficits in Parkinson disease. Semin Speech Lang. 2013;34(3):185-202. PubMed link
• D’Amelio et al. Long-term survival of Parkinson’s disease: A population-based study. J Neurol. 2006;253(1):33-7. PubMed link
• Jones & Ciuicci. Multimodal swallowing evaluation with high-resolution manometry reveals subtle swallowing changes in early and mid-stage Parkinson disease. J Parkinsons Dis. 2016;6(1):197-208. PubMed link
• Michou & Hamdy. Dysphagia in Parkinson’s disease: A therapeutic challenge? Expert Review of Neurotherapeutics. 2010;10:875-8. PubMed link
• Pflug, et al. Critical dysphagia is common in Parkinson disease and occurs even in early stages: A prospective cohort study. Dysphagia. 2018; 33(1):41-50. PubMed link
• Plowman-Prine, et al. The relationship between quality of life and swallowing in Parkinson’s disease. Mov Disord. 2009;24:1352-1358. PubMed link