Drooling (Sialorrhea) in Parkinson’s Disease Prevalence, Progression & What You Can Do

Although medication advancements and surgical interventions such as deep brain stimulation (DBS) have provided significant improvement in managing the motor symptoms of Parkinson’s disease, the non-motor symptoms — which can include drooling, dysphagia, sleep disorders, and anxiety — remain problematic for many individuals and have fewer available treatment options.

About the Research

Drooling in Parkinson’s Disease: Prevalence and Progression from the Non-Motor International Longitudinal Study reported on a retrospective analysis of 728 consecutive Idiopathic Parkinson’s Disease patients who had a baseline and follow-up assessment. Drooling was assessed using the Non-Motor Symptoms Scale (NMSS), and investigators also looked at prevalence of dysphagia through self-reported outcomes, along with Quality of Life and Cognitive assessments.

The aim was to assess whether the prevalence of drooling increases with age and negatively impacts quality of life.

Key Study Findings

Drooling occurs in all stages of PD and all ages, with highest prevalence in those over 80 years and with more than 15 years of disease duration.

At final follow-up (3 years), close to half of patients had drooling, reduced quality of life scores, and an association with cognitive impairment.

At final follow-up, nearly half also had dysphagia — though this may be an underestimate, as individuals with PD often under-report swallowing difficulties.

As high as 86% of people with drooling have been reported to have oral-pharyngeal dysphagia, with daytime drooling associated with silent aspiration.

⚠️ Clinical Recommendation

Because dysphagia commonly co-occurs in patients with drooling, Parkinson’s patients who drool should undergo a clinical and instrumental swallowing assessment. Drooling also has a high correlation with poorer quality of life, and management strategies should be offered to all patients.

 

What Can Be Done

Management Strategies

🍬
Chewing GumA simple strategy with no side effects. Chewing gum increases the flow of saliva and the rate of swallowing, helping to reduce drooling naturally. (South A R, Somers SM & Jog M S, 2010)
🩹
Terrycloth Sports Wrist BandA practical external cue that can prompt a person to swallow before wiping their mouth. More hygienic than tissues or handkerchiefs — and a gentle, non-medicinal reminder.
💉
Botulinum Toxin (Botox / Myobloc)Injections to the parotid and/or submandibular glands block acetylcholine release at the cholinergic parasympathetic secromotor fibers. May cause dry mouth, which can impact bolus formation and oral hygiene.
💊
Anticholinergic Medications / Atropine DropsSublingual atropine drops are an option, though increased side effects in elderly patients and associations with memory loss may limit their use.

“Drooling had a high correlation with poorer quality of life scores — management strategies should be offered to patients across all stages of Parkinson’s disease.”

ReferencesDysphagia (2020) 35:955–961 · https://doi.org/10.1007/s00455-020-10102-5 South A R, Somers SM & Jog M S (2010) · Nóbrega A C, Rodrigues B & Melo A (2008)
Scheduling a Swallowing Study in South Florida: Swallowing Diagnostics Inc., has been my mobile provider of instrumental swallowing assessments since 2009 when I entered private practice. Owner, Debra Tarakofsky, MS,CCC-SLP, is committed to ongoing Dysphagia education for her team as well as for patients and families. SDI’s mobile van comes directly to your home or facility to complete the exam. Because the study generates a recorded video, access to the video is available to me to review with patients prior to recommending swallowing treatment which may include swallowing exercises, diet consistency modifications and recommendations for what you can do at home to improve oral intake and swallowing safety. Visit my private practice page to learn more: https://voiceaerobicsdvd.com/voice-aerobics-private-practice/
Voice Aerobics Swallowing Diagnostics Van, Swallowing Diagnostics Inc.

 

My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Certified End of Life Specialist (CEOLS) * Voice Aerobics® A Whole Body Approach to Voice Practice

Voice Aerobics the heART and Science of Voice Practice