Parkinson’s disease can cause a person to have difficulty chewing and swallowing. This can have many effects on their health and quality of life. They can develop dry mouth, dehydration, or malnutrition. They can also aspirate (inhale) food, liquid, or saliva into their windpipe, which can be frightening. As one MyParkinsonsTeam member shared, “I recently started choking on my own spit, and for the first time ever, I got really scared because I couldn’t get any air.”
Difficulty swallowing (dysphagia) can be a challenging symptom of Parkinson’s. The good news is that it can be treated. Here’s what you need to know about this symptom, including why it happens and how it can be managed.
Many people diagnosed with Parkinson’s experience difficulties swallowing at some point while living with the condition. Dysphagia can occur at any point over the course of the disease, even during the early stages. As one member wrote, “I have trouble swallowing now. This is new to me — it’s only been a problem over this last week. It makes it hard to swallow my meds.”
Having trouble swallowing can cause many other problems, depending on why a person struggles to swallow and how severe their dysphagia is. Many people find that they drool or can’t keep food and drinks in their mouths. Others find themselves sputtering, choking, or dealing with a sore throat during or after meals. Some may not even realize there is a problem until they start losing weight without trying.
Some people with dysphagia start to avoid certain foods or drink fewer liquids when swallowing becomes difficult. Over long periods of time, this can lead to other problems. As one member observed, “My husband has had the same swallowing problems and was losing way too much weight.”
Swallowing involves the coordination of many complex muscle movements in the mouth and neck. Changes that lead to problems with swallowing can occur anywhere along the upper digestive tract, from the mouth to the esophagus.
In Parkinson’s, swallowing difficulties can be caused by the loss of dopamine neurons in different parts of the brain. If they are lost in the substantia nigra region in the midbrain, the problem is considered a motor symptom. However, losing dopamine neurons in the lower brain stem or the cortex can cause issues with coordination. This is considered a non-motor difficulty because the problem is with the coordination itself and not with the way the muscles are functioning.
Many risks are associated with swallowing problems. Unintended weight loss is common, as having problems swallowing may make a person less inclined to eat. Long-term dysphagia can also deprive a person of nutrients, leading to malnutrition.
Aspiration pneumonia is another potential problem. When swallowing is difficult, people can end up inhaling liquid, food particles, or saliva in their lungs. Since the lungs cannot get rid of these substances easily, an infection can develop. Sometimes, these infections can lead to significant illnesses like aspiration pneumonia.
You can do many things to manage swallowing problems associated with Parkinson’s. As the Parkinson’s Foundation notes, the first step to treating dysphagia is telling your neurologist about the problem. They can refer you to a specialist, known as a speech-language pathologist (SLP), for treatment.
The SLP will begin by asking you about the swallowing difficulties you’ve been experiencing. They will evaluate your symptoms and medical history. In most cases, they will order a video X-ray or an endoscopy to see how your swallowing muscles are functioning as you eat and drink.
After identifying the cause of your swallowing problems, the SLP will recommend one or more approaches to help you start swallowing and drinking as normally as possible. Some interventions may work for some people but not for others. You may have to try several before you find one that improves your swallowing.
Managing dysphagia often begins with treating the underlying cause. In swallowing problems caused by Parkinson’s, this can mean treating Parkinson’s with medication.
Many medications are available for people diagnosed with Parkinson’s. For example, levodopa helps ease stiff muscles and slow movements. As with most drugs, you might experience some side effects while taking levodopa. These can include constipation, dizziness, insomnia, and anxiety. If you experience any of these side effects while taking levodopa, let your health care provider know right away.
Finding the best drug treatment for your Parksinson’s might also improve your swallowing function. Swallowing problems don’t go away for everyone taking Parkinson’s medication, but there’s a good chance that you will see at least some improvement.
Some doctors, clinicians, and SLPs can administer a swallowing test or perform a swallowing study. These tests, as well as symptom questionnaires, can help indicate whether you are having problems swallowing and pinpoint where the dysfunction is occurring. After these procedures, doctors and speech specialists can target a person’s treatments so that they address the unique problems contributing to their 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.”
Another explained, “Your doctor may do a ‘swallow test’ on you, even if you’ve already had one, to see if things are worsening.”
Certain types of speech and language interventions may help improve your swallowing. Lee Silverman Voice Treatment (LSVT) is one type of treatment that seems to help people diagnosed with Parkinson’s swallow better. This approach helps you isolate certain muscles in the swallowing process and learn to strengthen or better control them while eating or drinking. Think of it as muscle strength training for swallowing.
Some of our members have had great success with this treatment. One 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!”
There are a number of changes that you can make to how you eat and drink that may make swallowing easier. These include:
At MyParkinsonsTeam, more than 85,000 members from around the world come together to ask questions, join ongoing conversations, and meet others who understand life with Parkinson’s.
Do you or your loved one have difficulty swallowing because of Parkinson’s? What has worked for you? Share your story and tips in the comments below or by posting on your Activities page.