Parkinson’s disease causes changes in movement, which can also affect the control and coordination involved in swallowing. This can cause difficulty in using the mouth and throat to swallow.

Difficulty swallowing, or dysphagia, can be a symptom of Parkinson’s disease. Swallowing problems can occur at any stage but may worsen as the disease progresses.

This article looks at signs to watch for, treatment and management strategies, and outlook.

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Parkinson’s disease is a progressive neurological disorder that affects several aspects of movement.

Changes in the areas of the brain that control movement cause symptoms such as:

Parkinson’s can also affect a person’s ability to control the muscles that allow them to speak and swallow normally. Swallowing requires the use of the muscles in the face, mouth, and throat.

Muscle coordination moves the food into the esophagus, the tube that connects the throat to the stomach, and prevents food or liquids from traveling down the airways to the lungs.

Parkinson’s causes motor and non-motor symptoms. Difficulty swallowing falls into both of these categories.

People with Parkinson’s have a loss of dopamine in the area of the brain that controls movement. This can impact how people swallow.

The biggest concern of dysphagia is aspiration. Aspiration occurs when food travels down into the lungs, which can cause aspiration pneumonia, a dangerous complication.

Symptoms of swallowing problems from Parkinson’s can include:

  • drooling
  • coughing or needing to clear the throat during or after eating or drinking
  • finding it hard to swallow certain foods or liquids, which may lead to avoidance of them
  • difficulty keeping food or drink inside the mouth
  • difficulty swallowing oral medications
  • food collecting around the gumline and in the mouth
  • feeling as though food is getting stuck in the throat
  • swallowing multiple times for each bite or sip

A person may experience side effects relating to their difficulty swallowing. These may include:

A person with Parkinson’s may also find themselves eating or drinking slowly. This is not a typical symptom of Parkinson’s, but a person may do it to avoid choking due to difficulty swallowing. It could also be due to the overall slow movements the disease causes.

Symptoms may be mild or severe.

Aspiration pneumonia

Aspiration pneumonia is a potentially serious complication of dysphagia. It happens when someone inhales food or drink into the lungs.

Aspiration pneumonia is hard to spot, but a person with the condition may experience fever and sudden difficulty breathing.

In a medical setting, a person with aspiration pneumonia may present with a low concentration of oxygen in the blood or a crackling sound from the lungs through a stethoscope.

Swallowing difficulties may occur at any stage of Parkinson’s.

At first, symptoms may be mild and not very noticeable. These symptoms may become more severe as the disease progresses.

It is important to notice signs as they start and seek early treatment to help prevent choking or aspiration.

Early stages

Swallowing difficulties can occur even in the early stages of Parkinson’s. Early diagnosis and treatment may help improve quality of life and reduce the risk of death.

Early signs to look out for include:

  • drooling
  • food collecting in the mouth
  • coughing or clearing throat when eating
  • difficulty swallowing medication
  • choking

These symptoms may cause a person to feel embarrassed. These feelings are normal. It is a perfectly acceptable reason to seek medical advice. Even mild dysphagia poses a risk of aspiration.

Later stages

Swallowing difficulties may gradually worsen as Parkinson’s progresses.

If present, swallowing problems typically become noticeable or problematic around 15 years after the onset of the disease, according to a 2020 research article.

In most people with Parkinson’s, severe swallowing difficulties occur in the advanced stages of the disease.

Healthcare professionals use the Hoehn and Yahr scale to define symptom progression in Parkinson’s.

Predictors of swallowing difficulties include:

  • stages 4 and 5 of Parkinson’s on the Hoehn and Yahr scale
  • significant weight loss or a body mass index (BMI) of under 20 kilograms per meter squared
  • drooling
  • dementia

Treatment and management techniques may help make swallowing easier and safer for people.

Choosing easier-to-swallow foods can also help. Swallowing exercises and therapy may help teach people how to swallow more efficiently with Parkinson’s.

Certain prescription medications, such as anticholinergic medications, can also help prevent excessive drooling. However, these medications have side effects. People can weigh the pros and cons with a doctor.

A healthcare professional can inject botulinum toxin (Botox) into a person’s salivary glands. This may prevent drooling by reducing saliva production while causing minimal side effects.

Swallowing therapy

Certain exercises may help people swallow more easily and safely.

Programs such as The Lee Silverman Voice Technique (LSVT) can help people exaggerate the act of swallowing.

Learning to swallow more forcefully may help people move food more easily from the mouth into the throat.

Swallowing therapy aims to maintain the ability to swallow for as long as possible to prevent malnutrition, dehydration, and complications affecting the lungs.

Swallowing therapy focuses on making eating and drinking safer, as well as retraining people on how to swallow with Parkinson’s to improve swallowing function.

In the early stages of Parkinson’s, swallowing therapy may help improve a person’s quality of life.

Swallowing therapy may focus on the specific areas of the mouth or throat causing people the most difficulty.

Swallowing therapy may include:

  • finding the best techniques for eating
  • practicing swallowing techniques with different types of food
  • doing exercises to help strengthen muscles in the mouth and throat
  • learning techniques to compensate for swallowing difficulties to increase safety
  • learning techniques to care for the mouth
  • learning to select certain foods or alter the texture of foods to make them easier to swallow
  • learning positions that are safer for swallowing
  • educating people and their families or caregivers on safe swallowing practices

Learn more about how physical therapy can help Parkinson’s disease.

Food changes

Changing the type of foods that people eat may help them eat more safely, such as:

People should try to avoid:

  • foods that need a lot of chewing
  • foods that are crumbly or very dry
  • thin liquids
  • chunky or hard foods

These suggestions are only guidelines. Acceptable foods will be different for every person. A speech and swallowing therapist can evaluate a person’s case and make suggestions that work for them.

Feeding tube

According to a 2020 review that included 93 participants with Parkinson’s and related disorders, as swallowing difficulties worsen, people may require a feeding tube to address weight loss and aspiration risk.

A percutaneous endoscopic gastrostomy (PEG) feeding tube is the most common form of feeding tube for long-term use. It may be a safe and effective feeding option in people with severe dysphagia.

Difficulty swallowing can lead to serious complications, including malnutrition, dehydration, and aspiration. Aspiration occurs when food travels down into the lungs. It can cause aspiration pneumonia.

Aspiration pneumonia is the leading cause of death in people with Parkinson’s, according to the Parkinson’s Foundation. Aspiration does not cause a person to cough or choke, so it can be difficult to notice.

Early treatment and proper management of dysphagia are important to help prevent complications such as aspiration and can help maintain health and quality of life.

A person should contact a doctor if they notice any signs of difficulty swallowing, even if the symptoms are mild.

Early intervention can help reduce the effect of swallowing difficulties and help keep people safe and comfortable when eating and drinking.

This section answers some frequently asked questions about Parkinson’s and swallowing.

What stage of Parkinson’s includes difficulty swallowing?

Difficulty swallowing can happen at any stage of Parkinson’s, including in its early stages.

Difficulty swallowing may begin with mild symptoms, such as causing a person to cough or clear their throat when eating. It may worsen as the condition progresses.

Does everyone with Parkinson’s have swallowing problems?

According to a 2021 review, difficulty swallowing is a common symptom of Parkinson’s. It may occur in 11–87% of cases.

This large variation is because dysphagia varies based on the stage of Parkinson’s.

Parkinson’s affects movement. It can also impact a person’s control and coordination of the muscles involved in swallowing.

People with Parkinson’s may experience difficulties swallowing at any stage, but symptoms may worsen as the disease progresses.

Early detection and treatment are important in managing the condition and preventing complications.

Swallowing exercises, swallowing therapy, food changes, and medications may help people manage swallowing difficulties and drooling.