Is Drooling A Sign Of Parkinson’s

By Jasmine S

December 22, 2021

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Role Of Saliva In Health And Well

Parkinson’s Disease and Drooling(Excessive Salivation), Reason, Management and Homeopathic Treatment

Two primary functions of saliva concern its role in maintaining oral pH and microbiotic homeostasis, and facilitating swallowing and speaking.4 6 Saliva possesses antimicrobial, anti-viral and anti-fungal properties which aid oral cleansing, protect against infection and support tissue repair it dilutes sugars and helps stabilize acidity it contributes to remineralization of dental enamel. It serves as a buffer for extremes of temperature or against noxious substances. It lubricates the oral cavity, thereby supporting formation and transport of the bolus to the pharynx. It acts as a first stage in digestion and stimulates interaction with chemosensory receptors to aid taste and smell perception. It supports smooth and accurate movement of the tongue and lips for speech.

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The Parkinson Canada Information and Referral Helpline is a toll-free Canada-wide number for people living with Parkinsons, their caregivers and health care professionals. We provide free and confidential non-medical information and referral services. When you have questions or need assistance, our information and referral staff help connect you with resources and community programs and services that can help you. We provide help by phone or email, Monday to Friday, 9:00 a.m. 5:00 p.m. ET.

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.

If You Have Swallowing Difficulty What Can Be Done

In some cases, swallowing function varies in response to dopamine medication doses, much like other aspects of motor function. Therefore, if swallowing becomes problematic, an increase in dopaminergic medications can be tried. In addition, make sure you undergo a swallow evaluation when you are in the ON state.

Even before a formal swallow study, you can take steps to increase the efficiency of your swallow. These include:

Sit upright during all eating and drinking, even when taking pills
Tilt the head slightly forward, not backward, as you swallow
Take small bites of food, chew thoroughly, and do not add any more food until everything from the first bite has been swallowed
Take small sips of liquid
Concentrate while moving the food backward in the mouth with the tongue
Double swallow if the food did not go down completely with the first swallow
Sometimes taking a sip of liquid between bites of food can help to wash the food down
If eating is very tiring, try several smaller meals spaced out during the day instead of three large meals.

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Difficulty Swallowing Or Eating

Parkinsons affects the muscles in the face, mouth, and throat that control speaking and swallowing. Dysphagia, or difficulty swallowing, is a symptom of Parkinsons that can lead to trouble eating.

It can lead to malnutrition, dehydration, or aspiration which happens when food or saliva goes down the wrong pipe and is inhaled into the lungs. Aspiration can lead to aspiration pneumonia, the leading cause of death in Parkinsons.

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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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 .

Prevalence Associated Factors And Negative Impacts Of Drooling In Pd

Managing hidden Parkinson’s symptoms

Due to the lack of a standard definition and criteria for diagnosing drooling in PD patients, estimates of prevalence vary. Previous studies showed that prevalence ranged from 10 to 84% . Various tools such as the Unified Parkinson’s Disease Rating Scale part II Scales for Outcomes in PD for Autonomic Symptoms PD non-motor symptoms questionnaire and different types of screening questionnaires were used to screen drooling. The factors associated with drooling have been reported. However, results vary among studies and the conclusion remains unclear. Factors possibly associated with drooling were severity of PD , male gender , aging , hallucinations , duration of PD , the sum of the scores of UPDRS part II and III greater than 28 points, dysarthria, dysphagia, orthostatic hypotension, and a history of using antidepressants . Drooling during PD can have negative impact for both patients and caregivers. Many negative physical sequelae were reported to follow the course of drooling such as perioral dermatitis, poor oral hygiene, bad breath, increased amount of intra-oral occult bacteria, eating and speaking difficulty, and an increased rate of respiratory tract infection from silent aspiration of saliva . Psychosocially, drooling PD patients showed poor quality of life , i.e., social embarrassment and increasing emotional distress . In addition, drooling patients affected their caregivers by increasing their burden, depression and anxiety, and reducing their QoL .

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Impaired Posture And Balance

Postural instability is the most difficult Parkinsons symptom to treat, and one of the most important criteria for diagnosing Parkinsons.

Postural instability is the inability to balance due to loss of postural reflexes and often leads to falls. Patients with impaired posture and balance might revert to a stooped posture and have a shuffling gait.

Management Of Saliva Flow

The British NICE guidelines for PD2 recommend referral to a speech-language clinician for assessment and treatment of drooling, though overall management is multidisciplinary. The guidelines advocate behavioral methods of intervention in the first instance, followed by consideration of pharmacological or surgical options if/when these are ineffective.

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Managing Eating And Swallowing

It is important to continue eating normally as long as it is safe to do so. This will help to keep your muscles working, and maintaining a healthy diet is vital to good health . Only when eating and swallowing become significantly uncomfortable or difficult should you adapt your diet, for example by eating pureed foods.

Swallowing difficulties are individual and solutions vary from person to person, but the following tips on diet, drinking and eating techniques may help.