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Swallowing and Parkinson’s Disease

Parkinsons disease (small)

Byline: Michelle Ciucci, PhD, CCC-SLP is an Assistant Professor in the Departments of Communication Sciences and Disorders, Surgery-Otolaryngology Head & Neck Surgery, and the Neuroscience Training Program at the University of Wisconsin-Madison. Michelle recently joined the NFOSD as a board member.

[Publisher note. Michelle Ciucci wrote this article for publication on the Michael J. Fox Foundation for Parkinson’s Research website. It was published on 11/5/2013 and can be viewed on their site by clicking here. The NFOSD is continually exploring ways in which we can work with other non-profit foundations where swallowing disorders present a significant risk to the members of their respective community’s.]

Fast facts:

– Swallowing difficulty can occur at any stage of PD.

– Evaluation and treatment of swallowing disorders are performed by a speech language pathologist.

– Swallowing disorders are treatable.

– The leading cause of death in PD is aspiration pneumonia due to swallowing disorders.

Difficulty swallowing, called dysphagia, can happen at any stage of Parkinson disease. Signs and symptoms can range from mild to severe and may include: difficulty swallowing certain foods or liquids, coughing or throat clearing during or after eating/drinking, and feeling as if food is getting stuck.  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 PD.

It is important to note any changes to swallowing, 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).

Treatment is specific to the nature of the swallowing problem, but can involve strategies to help food or liquid go down safely (swallowing hard, holding 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. Sometimes the signs of a swallowing disorder can be subtle, so it is important to be vigilant.  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 Foundation

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Ciucci MR, Grant LM, Rajamanickam EP, Blue KV, Hilby B, Jones, CJ Kelm-Nelson CA. Early

Identification and treatment of speech and swallowing disorders in Parkinson Disease. Seminars in Speech-Language Pathology, in press.