Trouble Moving Or Walking
Do you feel stiff in your body, arms or legs? Have others noticed that your arms dont swing like they used to when you walk? Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinson’s disease. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem stuck to the floor.
What is normal?If you have injured your arm or shoulder, you may not be able to use it as well until it is healed, or another illness like arthritis might cause the same symptom.
What Is Parkinsons Disease
Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.
Risk Factors For Drooling In Pd
If susceptibility to anterior drooling is not related to hypersalivation, other factors must be at work. Suggested candidates have been dysphagia, oro-facial rigidity/hypomimia, lingual bradykinesia, cognitive status, male gender and more advanced disease stage.23,24,28,31,39,43,50,51 Individuals with non-tremor dominant PD phenotypes were at higher risk of drooling.31,52 The precise contribution of these factors remains unsettled. The uncertainty rests partly on general issues above regarding why estimates of drooling prevalence and flow rates exist, but variability in individual profiles of impairment and disability also contributes.
Susceptibility of males probably relates to greater absolute flow rate when body mass and gland sizes are not controlled for though not all studies have found a male predominance.23,24,29 Relationship to greater disease severity likely reflects increased rigidity, poorer cognitive status and more marked dysphagia of later stages, and, in as far as medications may alter the picture, higher medication dependency.21
L-dopa can influence variables in swallowing efficiency,3,58 and thus indirectly change drooling. Currently, dysphagia study outcomes do not afford sufficient evidence to conclude a positive, neutral or negative effect of possible swallowing changes on sialorrhoea.
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Mechanisms For Drooling Disturbance In Pd
Patient reports of too much saliva in my mouth suggest hypersalivation as a cause. However, saliva production appears unchanged or even depressed in PD, indicating excessive salivation is not a crucial factor.26,3840,4547
Decreased salivary flow may relate to dysautonomia in PD. Hyposecretion may arise from medications common in PD.20,21,36 Altered reaction to stimulation, from reduced olfactory and other sensory triggers, may also play a role.48 Hou et al49 conducted a fMRI investigation to examine basal ganglia functional connectivity in drug-naïve people with PD who did or did not drool. Those with sialorrhea showed significantly reduced functional connectivity of putamen within bilateral sensorimotor cortices, superior and inferior parietal lobules and areas in the right occipital and temporal lobes.
Objective Measures Of Flow/volume
Objective measurements of milliliters or milligrams secretion per minute typically center around gathering saliva at regular intervals over given time periods.68,69 Sampling methods include collecting saliva from cups placed over salivary ducts, expectoration into pots or tubes, weighing of gauze or cotton rolls held at given loci in the mouth, use of centrifuges to extract saliva from the gauze to quantify the volume of saliva absorbed or allowing saliva to dribble from the mouth with the head held forwards over receptacles.
As secretion is sensitive to a number of influences, gathering ideally occurs under controlled conditions. Posture is controlled the environment is quiet, with absence or minimization of visual, olfactory or gustatory stimuli known to prompt increased flow. Comparability of stimulated flow across patients and time demands use of standard stimulatory material and doses . To assure inter- and intra-individual comparability, evaluations ideally happen at the same time of day at the same point in the drug cycle in the same relationship to meal times . Onoff status and fluctuations need to be monitored as well as presence and severity of dyskinesias that may affect measurements.70
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How Is Parkinsons Disease Treated
There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.
Stooping Or Hunching Over
Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease .
What is normal?If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.
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Measurement Of Related Variables
In as far as ptyalism in PD may be linked to other symptoms, other assessments may be pertinent to place real and perceived drooling in its broader context. These cover assessment of swallowing, speech and voice.3,65 Detailed dental examination and monitoring of oral health may be indicated for some individuals, over and above routine dental supervision.22,83
People with PD may experience dry mouth/xerostomia.21 Perceived dryness does not necessarily reflect objective levels of dryness defined by salivary flow rate/volume, mucosal wetness and saliva consistency.84 The Clinical Oral Dryness Score 85 is a validated clinician-administered semi-quantitative tool. The score comes from observing the presence/absence of ten symptoms and signs characteristic of dry mouth. It is combined with a 010 rating by the patient on how far they are bothered by xerostomia. Perceived impact has also been gauged using five questions related to possible activity and participation restrictions commonly reported by people with xerostomia.85
The PDQ3944 contains items on avoiding eating and drinking in public and speech/communication problems, but has nothing specific to drooling, despite several studies employing it as a sialorrhea rehabilitation outcome measure.
Treating Eating And Swallowing Difficulties
If you or someone you care for is experiencing difficulties with eating, swallowing or saliva control, the first step is to consult your doctor, who may refer you on to an SLT / SLP.
Your doctor may be able to adjust the timing and dose of medicines so that these are working well at mealtimes and so swallowing problems are better managed when eating. However, for some patients, medications do not affect the swallowing function.
Your doctor may also adjust your medications, or may prescribe new ones to reduce production of saliva. Some Parkinsons medicines, including levodopa, improve muscle movement and may help to reduce drooling. However, some medications, such as clozapine, which is prescribed for mental health problems, can actually increase saliva production.
Anticholinergic medications may help to reduce the amount of saliva you produce but are not suitable for everyone. For more information see Managing medication.
Botulinum toxin can be injected into the salivary glands to reduce saliva production. This treatment will not work for everyone and injections may need to be repeated every three to six months. However, for some patients, Botox injections are not recommended and may be dangerous.
In severe cases when other treatments are not effective, radiotherapy to the salivary glands can restrict saliva production. In extreme cases the salivary glands can be surgically removed as a last resort.
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Problems With Tongue Muscles
Parkinsons can also cause problems in the tongue muscles. The tongue is important in swallowing. We use it to move food around and push it to the back of the mouth to trigger the swallowing reflexes. Parkinsons can also impair the reflexes that protect our windpipe from food and drink. A problem coordinating breathing and swallowing may make this problem worse.
Eating Swallowing Problems And Saliva Control
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Eating and swallowing problems, known as dysphagia, occur in many medical conditions and become more common as we get older.
The main risks associated with swallowing problems are:
- Choking or asphyxiation: When food blocks the airway, preventing breathing. Also, when food or liquid enter the airway below the level of the vocal cords.
- Aspiration pneumonia: When food or liquid enter the lungs, this may cause a lung infection.
- Increased secretion: As a reaction to food or liquid entering the lungs.
- Dehydration: Lack of fluids can lead to problems such as constipation.
- Malnutrition: Lack of nourishment leads to poor health and harms the bodys ability to fight infection.
- Drooling: decrease in mouth sensitivity and / or a reduction in the frequence of swallowing saliva can cause drooling.
- Difficulties in swallowing medications.
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Normal Physiology Of Salivation And Swallowing
The processes of salivation are controlled by both sympathetic and parasympathetic nervous system. However, facilitation of ingestion and swallowing are mainly contributed by parasympathetic nervous system. The parasympathetic afferent pathways receive unconditioned reflex stimulation from the pharynx and esophagus. Then, signals are conducted via the vagus and spinal splanchnic nerves to the salivary center located in the medulla. The parasympathetic outputs are conducted via two different pathways including the glossopharyngeal nerve, which then innervates the otic ganglion, and, subsequently, to the parotid glands via the auriculotemporal nerve and the facial nerve through the chorda tympani nerve to the submandibular ganglia and then innervates the submandibular and sublingual glands via the lingual nerve .
Is Parkinsons Disease Inherited
Scientists have discovered gene mutations that are associated with Parkinsons disease.
There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.
Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.
Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.
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How Is Drooling Treated
Drooling isnt always treated. Doctors usually wont recommend any treatment for someone under the age of 4 or who drools during sleep.
Treatment may be recommended when drooling is severe. Drooling may be considered severe if saliva drips from your lip to your clothing or your drooling interferes with your daily activities and creates social problems.
Excessive drooling can also lead to inhaling saliva into the lungs, which can cause pneumonia.
Treatment options are looked at on a case-by-case basis, but generally your doctor will perform an assessment and come up with the management plan that works best for you.
The noninvasive approach includes trying things such as medication and oral motor therapy. In more serious cases, you and your doctor may consider a more invasive approach, including treatment options such as surgery and radiotherapy.
Swallowing Difficulties And Parkinsons Medication
If swallowing tablets or capsules becomes difficult, it may be tempting to crush tablets or open capsules, but this should never be done, as it can cause serious side effects and/or prevent the medication working properly. Always ask your pharmacist or doctor, or check the patient information leaflet before tampering with medicines in any way. Swallowing medications with jelly, yoghurt or apple sauce may help you swallow medication more comfortably.
Many Parkinsons medicines are prepared or designed to work in a particular way that will be harmed by crushing or opening capsules. For example, some medicines have:
- Sugar or film coating: This is usually to make them taste better, but crushing may make them taste unpleasant.
- Enteric coating: This coating is designed to keep the tablet whole in the stomach, in some cases to protect the stomach or to protect the medicine from stomach acid so that it is released after passing through the stomach, for example in the intestine. This type of tablet should never be crushed.
- Modified or controlled release: These medications have been designed to release slowly and act over a longer period, so they can be taken less often. Crushing this type of tablet would lead to a rapid release of the medicine which could be harmful.
If you experience any problems you should talk to your doctor, so that he or she can prescribe medication in a form that is easier to take. Some medicines are available in liquid form.
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Botox For Excessive Drooling
Injections of Botoxbotulinum toxin Adirectly into your salivary glands have also been used to try to stop excessive saliva in Parkinson’s disease. Although botox works for many people, the treatment carries a risk of side effects including too-dry of a mouth. Botox injections in this area can also make it difficult to swallow food.
The effects of the Botox only last for about three to four months, after which the procedure would need to be repeated. If you’re interested in trying this, make sure to look for a doctor experienced in this specific procedure, as serious side effects weakening your neck muscles so that you have problems swallowing are possible. Neurologists, pain management doctors, and physiatrists are healthcare providers with experience using botox for neurological causes. Most dermatologists use botox in their practices as well, but it is often more for cosmetic reasons.
Botox injections can also be pricey. Many insurance companies cover botox or part of the cost, but they do not cover all uses of Botox. Off-label uses are generally not covered. When Botox is covered for Parkinson’s it is typically for dystonia, involuntary muscle contractions. You’ll want to check with your insurance company to see if they cover botox for excessive drooling related to Parkinson’s.
Assessment Tools For Drooling In Pd
The assessment tools to evaluate drooling in PD include both objective and subjective measures. Objective tools were developed to measure the volume of saliva and salivary flow. The limitations of these tools are that they are time-consuming and cannot evaluate the psychosocial impairment. Therefore, subjective tools were developed. The subjective measures in many previous studies were the UPDRS part II salivary subscores to evaluate drooling treatment responses and visual analog scales to assess the frequency, familial and social distress however, not all scales are validated. Three drooling-specific rating scales including the Drooling Severity and Frequency Scale , Drooling Rating Scale and Sialorrhea Clinical Scale for PD have been used to evaluate drooling in PD. The DSFS, a semi-quantitative scale, was used in studies to evaluate drooling in PD and cerebral palsy . The scale is composed of two domains: the severity of drooling rated on a five-point scale and frequency of drooling rated on a four-point scale. Since the DSFS is easy to administer it is widely used. However, the limitations of this scale are no assessment of the psychosocial impact, no validation and no evidence of correlation between this scale and the objective measures of salivary secretion.
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Oral Dysfunction In Parkinsons: Swallowing Problems And Drooling
Two common and distressing problems that can develop in Parkinsons disease are swallowing dysfunction and drooling. I want to help you better understand these issues and learn what you can do to improve them so read on!
Thank you to Christine Sapienza, PhD, CCC-SLP and Bari Hoffman Ruddy, PhD, CCC-SLP for providing some of the material below.
Anxiety Drooling May Be Early Signs Of Parkinson’s Disease Study Suggests
Before the classic movement problems of Parkinson’s disease appear, more benign-seeming symptoms — such as anxiety and drooling — may occur, according to a new study in the journal Neurology.
“These results show that Parkinson’s affects many systems in the body, even in its earliest stages,” study researcher Tien K. Khoo, Ph.D., of the UK’s Newcastle University, said in a statement. “Often these symptoms affect people’s quality of life just as much if not more than the movement problems that come with the disease. Both doctors and patients need to bring these symptoms up and consider available treatments.”
For the study, researchers asked 159 people who had recently been diagnosed with Parkinson’s — as well as 99 age-matched people without Parkinson’s — to report whether they’d experienced any of 30 potential non-motor symptoms. These issues ranged from problems sleeping, to digestive issues, to sexual problems.
Researchers found that the people who had been diagnosed with Parkinson’s experience an average of eight of these problems, while those without Parkinson’s experienced an average of three problems.
The most common symptoms experienced by the people with Parkinson’s included drooling , constipation , and anxiety .
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Cognitive And Psychiatric Symptoms
- depression and anxiety
- mild cognitive impairment slight memory problems and problems with activities that require planning and organisation
- dementia a group of symptoms, including more severe memory problems, personality changes, seeing things that are not there and believing things that are not true