Written By: Renee Rouleau- B.S., PhD student, Jacobs School of Biomedical Sciences, University at Buffalo
This article of "Nutrition 101" focuses on dysphagia (difficulty swallowing) in individuals with Parkinson's Disease (PD). It highlights the risk of aspiration, where food or liquid enters the lungs instead of the stomach. The article aims to explore the symptom, its causes, implications, and management strategies.
Fact about Aspiration and Dysphagia:
It takes over 50 muscles to coordinate chewing and swallowing. (Ertekin, & Aydogdu, 2003)
In PD, these muscles move slower and less precisely, making it harder to chew, move food to the back of the mouth, and swallow safely.
This can lead to coughing, choking, and food getting stuck in the throat.
The longer food lingers, the greater the risk of aspiration (food or liquid entering the airway/lungs instead of the stomach).
Untreated dysphagia can lead to malnutrition, dehydration, and lung infections.
Dysphagia symptoms may start mild but worsen over time, affecting up to 80% of PD patients.(Kalf et al., 2012)
Key points about aspiration in PD:
Normally, the epiglottis prevents food from entering the airway.
In PD, slower reflexes can impair the epiglottis' function.
This can lead to "silent aspiration," where food enters the lungs without a cough reflex.
Aspiration pneumonia can result, requiring emergency care.
Early symptoms of aspiration pneumonia can mimic a cold or flu.
Worsening symptoms include chest pain, shortness of breath, and high fever.
To recognize and address aspiration:
Be aware of the risks and symptoms.
Seek medical attention if you suspect aspiration.
Early intervention is crucial to prevent serious complications.
Dysphagia symptoms can develop slowly, often leading to them being overlooked until a serious complication, such as pneumonia, occurs.
Common signs to watch for:
Taking longer to chew or swallow food.
Coughing or choking while eating or drinking.
Feeling like food is stuck in the throat.
Drooling or difficulty managing saliva.
A weak, hoarse, or gurgly voice after swallowing.
Unexplained weight loss.
Importance of seeking professional help: Even mild symptoms should be discussed with a neurologist or a speech-language pathologist (SLP).
Diagnostic tests:
SLPs can perform tests such as:
Modified barium swallow study (MBSS).
Fiber optic endoscopic evaluation of swallowing (FEES).
These tests help assess how food and liquid move through the throat, identify the source of the problem, determine symptom severity, and guide treatment.(Sutterup & Warnecke, 2015).
Note: It is critical that early detection and intervention for dysphagia in individuals with PD takes place to prevent serious complications. Those living with Parkinson’s and care partners must ensure to provide detailed information about symptoms and to ask questions about their health.
Lastly, let’s discuss the management of dysphagia (difficulty swallowing) and aspiration (food or liquid entering the lungs) in individuals with Parkinson's Disease (PD). Here's a summary of the key points:
Speech-language pathologists (SLPs) are experts in this area and can teach exercises to strengthen swallowing muscles.
SLPs can recommend strategies like eating smaller bites, chewing thoroughly and slowly, adjusting posture (sitting upright during meals and staying upright for at least 30 minutes afterward), and managing saliva production.
Diet modifications can be helpful, such as thickening liquids and avoiding foods that are hard to chew or swallow (e.g., nuts, dry crackers). (Cheng and Hamdy, 2022).
While there aren't specific medications for dysphagia or aspiration, maintaining a consistent schedule and dose for dopaminergic medications is crucial.
Hopefully we’ve illuminated an area that hasn’t been frequently addressed and made you aware of signs and symptoms of dysphagia so you can keep a lookout for yourself or as a care partner, as well as give you some good news concerning diagnosis and treatment! Remember to always give as much detail as possible concerning symptoms, and to start treatment early! No question is a dumb question when it’s about your health! Stay tuned for our next edition!
References:
Cheng I, Sasegbon A, Hamdy S. Dysphagia treatments in Parkinson's disease: A systematic review and meta-analysis. Neurogastroenterology & Motility. 2023; 35:e14517. doi:10.1111/nmo.14517
Ertekin, C., & Aydogdu, I. (2003). Neurophysiology of swallowing. Clinical Neurophysiology, 114(12), 2226-2244.
Kalf, J. G., de Swart, B. J. M., Bloem, B. R., & Munneke, M. (2012). Prevalence of oropharyngeal dysphagia in Parkinson’s disease: A meta-analysis. Parkinsonism & Related Disorders, 18(4), 311–315.
Suttrup, I., & Warnecke, T. (2016). Dysphagia in Parkinson's disease. Dysphagia, 31(1), 24–32. https://doi.org/10.1007/s00455-015-9671-9
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