Some individuals newly diagnosed with Parkinson’s disease, are surprised to learn that constipation, is a common, prodromal symptom (a symptom that precedes a diagnosis) of Idiopathic Parkinson’s disease. This early presentation of dysautonomia (disorders of the autonomic nervous system) may later be accompanied by sialorrhea (drooling) and dysphagia (swallowing disorder), a frequent and under-reported non-motor symptom.
Sialorrhea is defined as the involuntarily production of saliva beyond the lip margin, a normal phenomenon during childhood, but considered pathologic when it occurs beyond the fourth year of life. If there is reduced laryngeal sensitivity, saliva may be aspirated and bacteria from the oral cavity entering the lungs may lead to an aspiration pneumonia. Drooling can also be embarassing for individuals leading to a negative influence in their quality of life and in some instances even social isolation.
There’s no consensus in the literature as to what the cause is for drooling associated with Parkinson’s disease, however, there appears to be a strong relationship between drooling and dysphagia, and in fact, poor saliva management may be the first symptom of a swallowing disorder that a patient reports.
In a recent research study, investigators assessed drooling and associated symptoms in a large cohort of longitudinally followed PD patients. The aim of the study was to examine the prevalence of drooling, and its progression, across different age groups in patients with PD and assess the impact on quality of life.[i] 728 patients were assessed at baseline and in follow-up. Drooling occurred in 37.2% of cohort studied irrespective of stage of Parkinson’s, disease duration or gender. Drooling did appear to have an association with patient age, with the highest rates reported in those over 80 years of age. This study and others have suggested that drooling is often associated with dysphagia and also associated with cognitive performance, suggesting that cognitive decline may further contribute to the presence of sialorrhea.
Swallowing changes, like voice changes, appear to be among the earliest symptoms of Parkinson’s disease, but their subtle presence may not always be recognized or reported by patients. Speech pathologists can help with identification and treatment of these problems by utilizing sialorrhea screening tools and recommending early referral for an instrumental swallowing assessment when dysphagia is suspected.
[i] Drooling in Parkinson’s Disease: Prevalence and Progression from the Non‑motor International Longitudinal StudyDaniel J. van Wamelen1,2,3 · Valentina Leta1,2 · Julia Johnson2 · Claudia Lazcano Ocampo1,2,4 Aleksandra M. Podlewska1,2 · Katarina Rukavina1,2 · Alexandra Rizos1,2 · Pablo Martinez‑Martin5 ·Ray Chaudhuri1,2Dysphagia (2020) 35:955–961 https://doi.org/10.1007/s00455-020-10102-5
Read the following questions and circle your response. Share the results with your Neurologist and Speech-language Pathologist.
During the day, when do you feel there is more saliva in your mouth?
- At mealtimes.
- Throughout the day, not related to meals.
- All the time, even when I am asleep.
When you are asleep, how much saliva is there in your mouth?
- I don’t notice an increase in saliva.
- I notice increased amounts of saliva in my mouth, but my pillow doesn’t get wet.
- My pillow gets wet.
- My pillow and other bedclothes get wet.
While you are awake,
- I don’t drool.
- Saliva wets my lips.
- Saliva accumulates on my lips, but I don’t drool.
- I drool.
Does accumulation of saliva in your mouth impair your speech?
- I must swallow frequently to avoid difficulties.
- I have trouble speaking.
- I can’t speak at all.
- Does accumulation of saliva in your mouth impair your eating ability?
- I must swallow frequently to avoid difficulties.
- I have trouble eating.
- I can’t eat at all.
How many times do you drool during the daytime?
- Not more than 3 times
- I must carry a handkerchief with me all the time.
When you go out or on social occasions, does saliva accumulation bother you?
- I notice an accumulation, but it does not bother me.
- I realize other people notice it, but I can control the situation (for example, with a handkerchief).
- I have stopped attending social meetings
Ref: Sialorrhea Clinical Scale for PD
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I’m glad you found the information helpful, and that anyone bothered by drooling associated with Parkinson’s or other neurological disease discuss uption for reducing the problem with their physician.
I found this article very interesting, thanks for sharing
Glenn, thank you for your comment. Atropine is an anticholinergic medication, and by blocking the cholinergic receptors, it reduces saliva production. While it appears you have having a good response to the medication, caution is usually recommended when using Atropine in elderly because it may cause some undesirable side effects such as confusion, drowsiness or urinary retention.It’s important if using medication or Botox injections to reduce saliva that you are diligent with oral care.
My neurologist prescribed Atropine. One drop under the tongue at bedtime. Now I drool less often and lesser amount.
I am a 66 old PD patient who drools only at night. My neurologist prescribed one drop of Atropine under the tongue at bedtime. It’s not perfect but it helps a lot. Good luck.
Hello, David, it’s important for you to discuss your concern with your physician. An instrumental swallowing study may be indicated to r/o a swallowing problem that is causing or associated with the drooling. Chewing gum can help by increasing the flow of saliva and also increasing the rate or frequency of swallows. I often recommend wearing a sports terrycloth wrist band which can serve as a visual cue to swallow, and if needed, be used to wipe your mouth, keeping any germs on you and not on a tissue or handkerchief that gets set down. Your neurologist might recommend Botulinum injections, which can be effective, however, can also be too drying for some people, and that can aslo interfere with swallowing.
Mary how can I stop drooling