Many patients with Parkinson’s disease have dysphagia (difficulty swallowing) due to a loss of control of the mouth and throat muscles. This might make it difficult for the patient to chew and manage solid foods. A delay in the swallowing process in either the throat or pharynx (the digestive tube between the esophagus and mouth) might also make it difficult for the patient to swallow without coughing or choking.
Dysphagia increases the risk of aspiration (inhaling fluid or stomach contents) and pneumonia in patients with Parkinson’s disease. At times, making dietary changes and following special swallowing techniques are sufficient to improve the safety of swallowing. At other times, alternative means of providing fluids and nutrition are necessary.
Diagnosing swallowing problems
Careful evaluation of the patient’s swallowing is necessary. Nearly 25 percent of patients with Parkinson’s disease are "silent aspirators" and thus, patients that might seem at low-risk for aspiration might actually be at high-risk.
The proper evaluation should be performed by specially-trained speech pathologists. Often, a swallowing study using foods and liquids of varying consistency under video-fluoroscopy is necessary. The typical "barium swallow" performed by radiologists is usually insufficient and could lead to wrong conclusions.
Suggestions to help manage swallowing problems
Here are some suggestions to make chewing and swallowing easier and safer for you.
Positioning
Sit upright at a 90-degree angle.
Tilt your head slightly forward.
Remain sitting or standing upright for 15 to 20 minutes after eating a meal.
Dining environment
Minimize distractions in the area where you eat.
Stay focused on the tasks of eating and drinking.
Do not talk with food in your mouth.
Amount and rate
Eat slowly.
Cut your food into small pieces and chew it thoroughly.
Do not try to eat more than 1/2 teaspoon of your food at a time.
Swallowing
You might need to swallow two or three times per bite or sip.
If food or liquid catches in your throat, cough gently or clear your throat and swallow again before taking a breath. Repeat if necessary.
Concentrate on swallowing frequently.
Saliva management
Drink plenty of fluids.
Periodically suck on popsicles, ice chips, lemon ice, or lemon-flavored water to increase saliva, which will increase swallowing frequency.
Food consistency
If chewing is difficult or tiring:
Minimize (or eliminate) foods that require chewing, and eat more soft foods.
Puree your foods in a blender.
If thin liquids cause you to cough, thicken them with a liquid thickener. (Your speech pathologist can recommend one for you.) You can also substitute thin liquids with thicker liquid choices such as nectars for juices and cream soups for plain broths.
Taking medicines
Crush your pills and mix them with applesauce or pudding. However, some medicines, such as control-release levodopa/carbidopa (Sinemet CR), should not be crushed because this can affect how these medicines work.
Ask your pharmacist for his/her recommendations on which pills should not be crushed and which medicines can be purchased in a liquid form.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/30/2005
