On Parkinson’s and Swallowing

Elderly man drinking a glass of water

There’s been a lot of news lately regarding non-motor symptoms experienced by people with Parkinson’s Disease. I saw an article a while back that focused on it. I’m sorry to say that I didn’t think much of that article and can’t locate it now that I need it. The author managed to leave out just about every service that a Speech-Language Pathologist can provide to help people with Parkinson’s Disease (PwPD) maintain a functional quality of life! No mention of vocal changes. Not a word about cognition. At least swallowing problems (dysphagia) were the very first item on the list. Unfortunately, the author got that wrong, too. S/he stated that swallowing problems (dysphagia) are common in PwPD, but they are uncommon early in the course of the disease. I disagree!

It’s not that dysphagia is uncommon in early Parkinson’s. It’s more like the signs and symptoms of dysphagia are subtle and go unrecognized. In the author’s defense, dysphagia is often ignored by PwPD and their caregivers until a clearly defined problem arises, e.g. aspiration pneumonia. According to Evat et al 2009, dysphagia is part of a triad of problems that are symptomatic of dysautonomia, which is often diagnosed in PwPD. (Note: Dysautonomia is a malfunction of the autonomic body systems, e.g. heart rate, digestion, blood pressure, etc. See the Wikipedia article cited in References below for additional, basic information about the disorder.)

The following questions may help you identify subtle, early, non-motor signs of dysautonomia:

Do you have problems with excessive saliva production (sialorrhea)?

Do you cough and choke on various textures/consistencies of food/drink (dysphagia)?

Do you suffer from constipation, a problem for many PwPD?

It stands to reason that if the presence of dysphagia is so important to the diagnosis of the frequently experienced dysautonomia, then it is obviously experienced more frequently by PwPD than the author suggested.

In my humble opinion, no discussion of dysphagia in PwPD is complete without addressing changes in vocal quality (dysphonia)! Dysphonia is another symptom I was very sorry to see completely omitted from the article. Much solid research has been conducted regarding voice disorders in PwPD.  Communication is very important to humans. It contributes to our self-identity. We use it to expresses our wants, needs, and to interact socially. When voice is compromised, our quality of life suffers.

But… the vocal folds (cords) were not created for speech. Humans adapted them for expressive communication; however, their first and primary function is to protect the airway during the swallow! When a person presents with a breathy, hoarse voice and weak, uncoordinated breath support, I am typically concerned about the integrity and safety of the swallow first and foremost.

I’ve said in other blog posts that my philosophy is to think proactively vs. reactively. Increased awareness of non-motor symptoms of PD is a very good thing. It allows PwPD to notice changes early and seek help to preserve function as long as possible. I know the message that exercise is very important for management of PD symptoms is gaining acceptance. Please remember that muscles are also a part of the speech/voice/ swallowing system! Those muscles can decondition just like any other muscle in the body. A Speech-Language Pathologist can help you get them back into shape!

References

Evatt, M. L., Chaudhuri, K. R., Chou, K. L., Cubo, E., Hinson, V., Kompoliti, K., Yang, C., Poewe, W., Rascol, O., Sampaio, C., Stebbins, G. T. and Goetz, C. G. (2009), Dysautonomia rating scales in Parkinson’s disease: Sialorrhea, dysphagia, and constipation—Critique and recommendations by movement disorders  task force on rating scales for Parkinson’s disease. Mov. Disord., 24: 635–646. doi: 10.1002/mds.22260

Dysautonomia. (2013, July 30).  In Wikipedia, The Free Encyclopedia. Retrieved 00:30, August 19, 2013, from http://en.wikipedia.org/w/index.php?title=Dysautonomia&oldid=566402321

CyndeeBlue2

Cynthia Williams Bowen, MS, CCC-SLP owns Bowen Speech-Language Therapy, LLC in Clearwater, FL.  Cyndee provides quality, creative, collaborative treatment to adults and adolescents with communication, swallowing, Parkinson’s, and related disorders.

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