For many years, a local neurologist has referred most of his early Parkinson’s patients for a comprehensive speech and swallowing evaluation. While I have always appreciated his acknowledgement of the incidious nature of these problems, the patients are often less appreciative of the referral, often asking to postpone a visit, stating: “my speech is not that bad yet,” or “I don’t think I’m having any swallowing problems,” although they admit to drooling.
A number of investigators have reported that poor awareness of swallowing difficulties is common among people with Parkinson’s(Miller et al, 2009). In fact,depending on how sensitively dysphagia is measured and treatments are introduced, swallowing problems occur in nearly 100% of individuals with PD at some time in the disease course; swallowing changes occur from the earliest stages, and even in asymptomatic patients characterizing them, along with speech, as prodromal symptoms of Parkinson’s disease (i.e. occuring before the motor symptoms), consequently in the case of dysphagia and PD, it may be better to assume “guilty” than presume innocent.
Drooling is a common complaint of patients with PD and has been identified as having a high relationship to oral-pharyngeal dysphagia, and when patients with a complaint of daytime drooling were evaluated by modified barium swallow study, an imaging exam, changes in the oral stage of swallowing were seen in 100% of patients; and 94% in the pharyngeal stage of swallowing.
The take away from much of the swallowing research and Parkinson’s is that although dysphagia is a common symptom of Parkinson’s, many people with PD may not report a swallowing problem if asked simply: “do you have a swallowing problem?” Screening tools administered to patients in collaboration with carepartners can be helpful, but even they may be misleading. Clinical and instrumental swallowing assessments are essential and even early in the disease may help to identify problems, provide a baseline for any future changes, and serve as a foundation for education and training in strategies and swallowing exercises that may yield benefit.
Want to Learn More about Swallowing and Parkinson’s disease?
On Thursday, October 25, 2018, The Venice Movers and Shakers PD Discussion group, Venice, Florida ,will host Mary Spremulli,MA,CCC-SLP for a lecture and discussion: Swallowing and Parkinson’s disease.
The lecture will be held from 3:00-5:00pm at the Jacaranda Public Library 44143 Woodmere Park Blvd. Venice, Fl. Anyone with Parkinson’s and their carepartner/caregiver is welcome to attend this free lecture. Please RSVP Carisa Campenella, Neurochallenge Foundations: 941-928-5886
References: Miller N, Allcock L, Hildreth AJ et al (2009) Swallowing problems in Parkinson disease: Frequency and clinical correlates. J Neurol Neurosurg Psychiatry 80(9): 1047-9 Eadie & Tyler, 1965; Miller et al., 2007; Martinez-Martin et al., 2007; Verbann et al., 2007