Parkinson’s disease can cause unexpected symptoms, including difficulty chewing and swallowing. When swallowing is affected, complications like dehydration and malnutrition can occur.

Swallowing problems can also cause aspiration (inhalation) of food, liquid, or saliva into the windpipe. In some cases, aspiration can lead to pneumonia, which can be life-threatening.

As one MyParkinsonsTeam member shared, “I recently started choking on my own spit. For the first time ever, I got really scared because I couldn’t get any air.”

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Trouble swallowing (dysphagia) can be a challenging symptom of Parkinson’s. The good news is that it can be managed. Here’s what you need to know about this symptom, including why it happens and how to manage it.

Why Does Parkinson’s Cause Difficulty Swallowing?

Swallowing involves coordinating many complex muscle movements in the mouth and throat. Neurological changes from Parkinson’s disease that lead to swallowing problems can occur anywhere from the mouth to the esophagus.

In Parkinson’s disease, swallowing issues can be caused by various mechanisms, including the loss of dopamine neurons in the brain. Different muscles need to work together when you swallow. That’s why neuron loss can affect both muscle control and how muscles coordinate.

Swallowing issues can be considered either a motor symptom or a nonmotor symptom, depending on how they affect you.

Manage Swallowing Problems With Parkinson’s

You can take steps to manage swallowing problems linked with Parkinson’s disease. First, talk to your neurologist if you’re having trouble swallowing. They can refer you to a specialist, known as a speech-language pathologist (SLP), for evaluation and treatment.

The SLP will begin by asking you about the swallowing issues you’re having. They’ll review your symptoms and medical history. Recommended tests for diagnosing and evaluating dysphagia include:

• Clinical bedside swallow evaluation (CSE) — A doctor reviews symptoms as you swallow.
• Videofluoroscopic swallow study (VFSS), also known as modified barium swallow study — A moving X-ray is used to evaluate swallowing in real time.
• Fiberoptic endoscopic evaluation (FEES) — A thin, flexible imaging device is inserted through the nose to view the throat while swallowing.

After a swallowing evaluation, the SLP will make recommendations to help improve your swallowing and quality of life.

Treat Parkinson’s With Medication

Managing dysphagia often begins with treating the underlying cause. If the swallowing problems happen at the same time that Parkinson’s symptoms are worsening, treatment with Parkinson’s medication may be needed.

Dopaminergic medications, such as levodopa, help ease stiff muscles and slow movements linked to Parkinson’s disease. As with most drugs, you might have side effects while taking levodopa. These can include constipation, dizziness, insomnia, and anxiety.

If you have any of these side effects while taking levodopa, let your healthcare provider know right away. Always get medical advice before changing your Parkinson’s treatment plan.

Finding the best treatment option for your Parkinson’s might improve your swallowing function. However, Parkinson’s medication may not help in treating swallowing problems, even if other symptoms are well-managed.

Get a Swallow Test

If your swallowing doesn’t get better with Parkinson’s treatment, your doctor may recommend a swallowing test. This can help pinpoint where the problem is happening. Your doctor and SLP can create a treatment plan just for you to address the problems causing your dysphagia.

Some MyParkinsonsTeam members recommend these tests to anyone who struggles with swallowing. One member told another, “Please ask your doctor to order a barium swallow test to determine why you have difficulty swallowing.”

A modified barium swallow test is typically used for swallowing problems related to Parkinson’s. If your doctor suspects other problems in your esophagus may be causing swallowing issues, they may recommend a conventional barium swallow test.

One member said, “Your doctor may do a ‘swallow test’ on you, even if you’ve already had one, to see if things are worsening.”

Work With a Speech-Language Pathologist

SLPs are trained in several types of therapeutic approaches that may help with safe swallowing. Two rehabilitation therapies that have been shown to be effective in some people with Parkinson’s include:

• Expiratory Muscle Strength Training (EMST) — Uses a device to help make swallowing muscles stronger
• Neuromuscular electrical stimulation (NMES) — Uses electrical currents and specific exercises to control muscle contractions in swallowing

Lee Silverman Voice Treatment (LSVT) is a type of voice therapy for people with Parkinson’s that has also been found to improve swallowing in some people.

A MyParkinsonsTeam member shared their experience: “I finally found a great speech therapist in my area who is well-trained in LSVT. I’ve worked with her for two years. She has me 80 percent to 90 percent better. It works, but it does take discipline doing daily exercises and not giving up!”

An SLP can work with you to find an approach that’s right for your particular condition.

Change How You Eat and Drink

You can make changes to how you eat and drink that may make swallowing easier. These include the following:

• Take small sips of drinks and small bites of food.
• Eat and drink when your medication is most effective, rather than right after you take it or when it wears off.
• Sit up as straight as possible when eating and drinking.
• Reduce distractions, like conversations, during mealtimes.
• Swallow saliva regularly to control excess saliva or drooling.
• Focus on keeping your mouth closed while eating and drinking.

Your doctor or SLP may also recommend changing the thickness or texture of the foods you eat. Do this only with clear guidelines from your healthcare provider, because these types of changes may affect hydration and nutrition.

In addition, good oral care can help control mouth bacteria and help reduce the risk of developing aspiration pneumonia.