For individuals with Parkinson’s, the simple act of swallowing, usually effortless, can become a source of quiet concern. From managing saliva to enjoying a meal, this once automatic function might now bring a persistent cough, a feeling of food getting stuck, or even the fear of choking. 

These swallowing problems are common in Parkinson’s. Understanding their root cause and how to effectively manage them is crucial for preventing complications that can impact nutrition, safety, and overall health.

What Causes Swallowing Problems in Parkinson’s?

More than 80% of people with Parkinson’s develop swallowing challenges, known as dysphagia. It does not typically appear as a sudden inability to swallow, but rather as subtle, progressive changes that disrupt the coordinated process of moving food and liquids from the mouth to the stomach.

The core reason behind these difficulties lies in the crucial neurotransmitter, dopamine. Swallowing is a complex automatic movement, involving dozens of muscles working in perfect harmony. Dopamine is essential for planning and controlling these automatic muscle movements. As the dopamine-producing cells in the brain degenerate or become impaired in Parkinson’s, this automatic coordination is disrupted, making the swallowing process challenging. 

Initially, dysphagia may appear mildly with issues such as taking a longer time to eat a meal or coughing at mealtimes. However, it’s vital to recognize that it can progress over time to become a critical symptom of Parkinson’s disease, significantly reducing overall quality of life and impacting daily functioning. 

What Are the Symptoms of a Swallowing Disorder?

Swallowing problems may not be immediately recognized, or they might be attributed to other causes. Early identification and intervention are key to preventing more serious complications.

Some of the common symptoms of a swallowing disorder in Parkinson’s include:

• Drooling or Difficulty Controlling Saliva: Normally, humans automatically swallow saliva throughout the day without thinking. With reduced dopamine, this automatic swallowing diminishes, leading to saliva accumulating in the mouth, causing drooling.
• Coughing While Eating or Drinking: This can be an important warning sign that food or liquid might be entering the airway instead of the esophagus.
• A Wet or Gurgly Vocal Quality: After swallowing, the voice might sound wet, gurgly, or raspy, suggesting that food or liquid may have  reached the vocal folds or is lingering in the throat. Eating mixed consistencies, like cereal and milk or watermelon, which is more than 90% water, may be uncoordinated, resulting in some liquid falling back in the throat before the swallow is initiated.       
• Feeling Like Food or Pills Are Getting Stuck in the Throat: This sensation can occur because the muscles aren’t moving the bolus (chewed food or liquid) efficiently through the pharynx or esophagus.
• Unexplained Weight Loss: If a person is struggling to swallow, they may begin to eat less, or their body might not be processing nutrients efficiently, leading to unintentional weight loss.

The Swallowing and Speech Connection

A key fact often overlooked is that the muscles used for speaking are the same ones responsible for swallowing. An estimated 90% of individuals with Parkinson’s are likely to develop a speech disorder, with common symptoms including a softer voice, gravely vocal quality, flat intonation (monotone), or trailing off at the end of sentences. Therefore, if these vocal or speech changes are noticed, it’s an indicator that swallowing problems may also develop.

When swallowing problems go unaddressed, they can lead to serious consequences such as malnutrition, dehydration, and aspiration – when food or liquid enters the airway instead of the esophagus, potentially causing respiratory complications. Beyond the physical risks, difficulties with eating and drinking can also affect comfort at mealtimes, reduce quality of life, and lead to social withdrawal.

That’s why early intervention is so important after a Parkinson’s diagnosis. It can significantly improve outcomes and help individuals RETAIN and REGAIN control of their speech and swallowing.

Overcoming Swallowing Problems with INTENT

While the insufficiency of dopamine in Parkinson’s can impair automatic movements like swallowing, there’s an empowering way to reclaim control. Our bodies possess two motor systems: an automatic motor system, heavily reliant on dopamine, and an intentional motor system that is less dopamine dependent.

This means that when people with Parkinson’s consciously engage their intentional motor system by using INTENT – when they are deliberate, focused, and purposeful – impulses can bypass the areas where dopamine is usually produced. They learn to chew and swallow with intent, resulting in a safer and more enjoyable dining experience. 

INTENT is the key to managing Parkinson’s and is the focus of Parkinson Voice Project’s highly effective SPEAK OUT!^® Therapy Program. SPEAK OUT! Therapy empowers individuals with Parkinson’s to use INTENT for both speech and swallowing. Through one-on-one sessions with a Speech-Language Pathologist, consistent daily home practice, and SPEAK OUT! Class sessions, individuals with Parkinson’s learn to convert these once automatic functions into intentional acts. As the muscles get stronger and the understanding of how to use intent improves, people with Parkinson’s are able to RETAIN and REGAIN their speech and swallowing. 

To better understand the causes and symptoms of a swallowing disorder in Parkinson’s and how SPEAK OUT! Therapy helps, watch our video: “What is Parkinson’s?”