Dysphagia

Key Facts

  • Dysphagia is common in PD but under diagnosed.
  • Video fluoroscopy is the gold standard for diagnosis.
  • Swallowing therapy is important for management.
  • Aspiration pneumonia is common cause of hospitalization in PD.
  • Recent weight loss or recent respiratory infections may be the clue to diagnosing dysphagia.

Clinical Best Practices

  • Inquire regularly as to any symptoms.
  • Rule out other contributory factors to dysphagia or coughing is essential, including gastrointestinal reflux, which can mimic dysphagia.
  • Refer to speech-language pathologist.

Prevalence of dysphagia varies widely among PD population typically increasing in prevalence with stage of illness.  It is linked to increased morbidity and mortality.

Significant dysphagia is most commonly encountered in late moderate to more advanced patients.

Common Causes

  • Lingual tremor
  • Impaired pharyngeal peristalsis
  • Restricted opening of the upper esophageal sphincter

Diagnosis

  • Comprehensive medical history and physical examination
  • Video fluoroscopy is gold standard for diagnosis
  • Symptoms include: drooling, wet cough, choking or coughing while eating, wet voice, food in sputum, and pharyngeal discomfort during eating
  • Endoscopy
  • Barium swallow study

Barriers to Diagnosis

  • Lack of disclosure

Treatment Options

  • Swallowing therapy
  • Diet
  • Feeding tube may be necessary in advance dysphagia

Complications of Dysphagia

  • Aspiration
  • Silent aspiration
  • Malnutrition
  • Dehydration
  • Decreased quality of life
  • Pneumonia
  • Weight loss
References: 

Wood LD, Neumiller JL, Setter SM, Dobbins EK. Clinical review of treatment options for select nonmotor symptoms of Parkinson’s disease. Am J Geriatr Pharmacother. 2010;8(4):294-315.

Factor SA, Weiner WJ, eds. Parkinson’s Disease: Diagnosis and Clinical Management. 2nd ed. New York, NY: Demos Medical Publishing; 2008.