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HomeCureIs Drooling A Sign Of Parkinson's

Is Drooling A Sign Of Parkinson’s

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.46 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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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

Parkinsons &  Drooling

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.

Drooling Is No Early Sign Of Dysphagia In Parkinsons Disease

Parkinsons disease: Drooling, gurgled voice, coughing and ...

Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Correspondence

A. Niessen

Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

C. Pflug

Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Correspondence

A. Niessen

Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

C. Pflug

Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Funding information

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Swallowing Difficulties In Parkinsons Disease

The act of swallowing involves a complex series of activities that begin in the mouth, continue in the pharynx and end in the esophagus. These include chewing, using the tongue to move the bolus of food to the back of the throat and then coordinating the muscles that both propel the food into the esophagus and protect the airway or trachea from food penetration. Swallowing dysfunction can be considered both a motor and a non-motor symptom of PD. Loss of dopamine neurons in the substantia nigra area of the brain can cause the motor dysfunction that impairs swallowing. However, loss of neurons in other areas of the brain, such as the cortex and lower brain stem can also affect the overall control and coordination of swallowing, and can be thought of as a non-motor symptom of PD. Swallowing issues are very important to diagnose. Impacts on your daily life and your health can range from difficulties with meals to more extreme cases where it could lead to choking and aspiration which can be very serious or even fatal.

Pathophysiology Of Drooling In Pd

In addition, a recent study showed that severe hypomimia, unintentional mouth opening and stooped posture with dropped head, could cause drooling in PD patients by losing the ability to maintain saliva within the oral cavity . In contrast, there is no obvious evidence that medication-induced dyskinesia can produce drooling. The possible domains contributing to the pathophysiology of drooling in PD are summarized in .

Possible pathophysiology of drooling in Parkinson’s disease

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Swallowing Exercises Can Be Very Helpful To Improve Your Swallowing

After a formal swallow assessment, swallowing therapy sessions can be designed for you, involving exercises tailored to the specific parts of your mouth and throat that are causing the swallowing problem. Sessions may involve practicing compensatory swallowing strategies with various types of foods in order to maximize safety and efficiency while swallowing.

During swallow therapy, recommendations may include:

  • Best feeding techniques
  • Exercises to strengthen oral and throat muscles
  • Compensatory techniques to assist in safe swallowing
  • Oral and mouth care techniques
  • Appropriate food selection and ways to modify food texture
  • Safe positioning strategies

Mechanisms For Drooling Disturbance In Pd

Parkinsons Disease

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.

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Low Blood Pressure When Standing

Orthostatic hypotension refers to a persistent drop in blood pressure that occurs when you move from sitting to standing, or from lying down to sitting up or standing. It can cause:

  • dizziness
  • headache
  • feeling faint

OH is defined as a blood pressure drop of 20 millimeters of mercury in systolic blood pressure, or a drop of 10 millimeters in diastolic blood pressure.

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 medical professional experienced in this specific procedure, as serious side effects weakening your neck muscles so that you have problems swallowing are possible. Neurologists, pain management healthcare providers, 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.

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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.

Excessive Saliva And Drooling In Parkinsons

Parkinsons disease: Early mouth signs can include ...

Saliva is needed for the first stages of digestion, including chewing and swallowing. This watery substance contains enzymes that start to digest our food.

Many people with Parkinsons experience poor saliva control, which may result in excessive saliva and drooling, or alternatively, in a dry mouth and other eating problems.

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Depression May Be An Early Symptom Of Parkinsons

Depression is one of the most common, and most disabling, non-motor symptoms of Parkinsons disease. As many as 50 per cent of people with Parkinsons experience the symptoms of clinical depression at some stage of the disease. Some people experience depression up to a decade or more before experiencing any motor symptoms of Parkinsons.

Clinical depression and anxiety are underdiagnosed symptoms of Parkinsons. Researchers believe that depression and anxiety in Parkinsons disease may be due to chemical and physical changes in the area of the brain that affect mood as well as movement. These changes are caused by the disease itself.

Here are some suggestions to help identify depression in Parkinsons:

  • Mention changes in mood to your physician if they do not ask you about these conditions.
  • Complete our Geriatric Depression Scale-15 to record your feelings so you can discuss symptoms with your doctor. Download the answer key and compare your responses.
  • delusions and impulse control disorders

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