Watch for warning signs including issues with eating, swallowing, choking and coughing.
Swallowing and chewing difficulties (dysphagia) can significantly impact the lives of people with Parkinson’s and their care partners. An estimated four out of five people with Parkinson’s may experience chewing and swallowing difficulties, which often go unrecognised without assessment by a medical professional.
Parkinson’s & swallowing
Parkinson’s can cause slow movements, create difficulty starting a movement, and make movements smaller. People with Parkinson’s can experience this in the mouth and throat. Other symptoms can impact these movements including mood, fatigue and posture.
Eating, drinking and swallowing are automatic skills – when you must focus on talking, thinking, reading or television, these other skills may not work as well.
People with Parkinson’s experience drooling, or siahlorrhoea because they swallow less often, so saliva can build up. This can be embarrassing and limit social interactions, as can issues with eating.
When food, fluid, saliva, or medication get into the airway without a cough response it can lead to serious health issues.
Your care team can address chewing and swallowing difficulties. Swallowing therapy is often the main treatment and Parkinson’s medication adjustments may help swallowing problems, as will exercises to strengthen swallowing muscles.
It is best to get an early assessment of your speech and swallowing to establish a baseline and get some tips to maintain the best quality eating, swallowing and saliva control. You can continue to enjoy meals, have confidence in public and safely chew and swallow.
Recognising swallowing issues
Swallowing and chewing problems are common for people with Parkinson’s and can worsen over time. Warning signs and symptoms can include one or more of the following:
- increased eating time (meal duration)
- post-swallowing coughing
- post-swallowing gurgling voice
- drooling
- choking
- breathing disturbance
- unintentional weight loss
- difficulty swallowing medication
- sensations of food retention
- one or more episodes of pneumonia.
Which professionals can help?
Talk to your GP as soon as you can if you have problems with eating or swallowing – they may refer you to specialists who can help.
Ask to see a speech pathologist as soon as you are diagnosed. They can do a baseline assessment of swallowing and deliver an exercise plan. Speech pathologists will examine your lips, tongue, soft palate and voice box, and check how you eat, drink and swallow your medication. A speech pathologist can also teach exercises and provide you with tips for safe chewing and swallowing actions. They can also help with saliva control techniques. Speech Pathology Australia – Find a Speech Pathologist (www.speechpathologyaustralia.org.au) can be used to find your nearest provider. Advances in technology-enabled care increasingly support home-based multidisciplinary care. Tele-rehabilitation offers the possibility of communication and swallowing assessment and interventions for people with Parkinson’s and is endorsed by Speech Pathology Australia.
They may also refer you to an ENT (ear, nose and throat specialist) or gastroenterologist to assess and rule out any internal structural problems.
A dietitian can modify your diet and advise you on good food and fluid choices. Major hospitals and community health centres may offer the required services; alternatively, Dietitians Australia – Find a dietitian (https://member.dietitiansaustralia.org.au/faapd) can be used to find your closest dietitian services.
An occupational therapist can help you find the best way of sitting for meals and the right cutlery aids and equipment for making eating and drinking easier.
A physiotherapist may also help you find the best way of sitting for meals, which is important for swallowing. Chest physiotherapy can help keep your airways clear by shifting mucous out of the lungs.
A dentist may be able to help monitor the health of your mouth and teeth problems arising from these symptoms.
Swallowing tips
Using these tips, you can feel safe and comfortable while eating and reduce the risk of things going down the wrong way.
- See a multidisciplinary team as mentioned above, and bring your carer or friend along so they understand the issues that affect your swallowing.
- Stay hydrated.
- Be mindful when chewing, eating and swallowing.
- Adjust your seated posture and head position when eating or drinking.
- Take smaller bites, cut food into smaller pieces and eat more slowly.
- Get advice about your diet and modify textures and consistency.
- Thicken liquids.
- Make smoothies to make eating green, leafy vegetables and fruits easier.
- If advised, limit dairy which may increase mucous production.
- Do your exercises regularly for best results.
- Set goals with your therapist and review regularly.
- Chewing gum or sucking on sweets may help you swallow more regularly.
- Ask about medications and surgical treatments that can help with dry mouth and saliva production.
Swallowing changes may occur as your condition progresses so be proactive in preserving swallowing strength and managing your symptoms by getting assessed early.
See also Communication & Parkinson’s and Dental Health & Parkinson’s information sheets.
References
(1) Suttrup, I., & Warnecke, T. (2016). Dysphagia in Parkinson’s Disease. Dysphagia, 31(1), 24–32. https://doi.org/10.1007/s00455-015-9671-9
(2) Ireland, S. et al. Recognising and responding to communication and swallowing difficulties in Parkinson’s disease. AJGP 2022; 51(4): doi: 10.31128/AJGP-07-21-6094
(3) Tjaden K. Speech and Swallowing in Parkinson’s Disease. Top Geriatr Rehabil. 2008; 24(2):115-126. doi: 10.1097/01.TGR.0000318899.87690.44. PMID: 19946386; PMCID: PMC2784698.
