Dear Doctors: A friend who has Parkinson’s disease is starting to have trouble swallowing. Can you explain why that is? I thought Parkinson’s mainly affects the hands and limbs. Also, she and her husband are often dinner guests at our home. What foods are easiest for her to manage?
Dear Reader: Parkinson’s disease is a progressive neurological disorder in which ongoing changes in the brain affect and interfere with movement. This occurs due to a disruption in the production of dopamine, a neurotransmitter that is essential to smooth and continuous muscle movement. Although the cause of the disease is not yet known, an emerging body of research suggests a link to the microflora of the gut microbiome.
The physical effects of Parkinson’s disease include the onset and gradual worsening of symptoms such as resting tremor, muscle stiffness and rigidity, slowed movement, muscle weakness, poor balance and diminished motor coordination. You are correct that these are most noticeable in the hands, arms and legs. However, muscle weakness and loss of motor control often also affect the jaw, mouth, tongue and trachea. This makes it difficult to chew food properly and impairs swallowing.
Difficulty in swallowing, which is common in Parkinson’s disease, is a condition known as dysphagia. Symptoms include struggling or being unable to swallow, incomplete swallowing, a sensation that food is stuck in the throat, coughing or gagging during a swallow, regurgitation and heartburn. Some people may experience drooling or develop a hoarse voice. Dysphagia also increases the risk of aspiration, which is when food accidentally enters the airways.
People living with Parkinson’s disease face several challenges when eating. One is the motor control needed to select a bite of food and carry it to the mouth. Many find that using a large spoon, or even their fingers, makes this easier. You can ask your friend, or her spouse, if she has a preference in tableware. You can provide her with a tablespoon or make it clear that you would be happy to include her own cutlery in the table setting. Because coughing and drooling may occur, be sure to provide her with several large and absorbent napkins.
When someone has trouble swallowing, foods that are soft and moistened are easiest to manage. You might consider a stew, which typically consists of fork-tender, bite-sized pieces. A soup made with pureed vegetables would offer the thicker consistency that is both easier and safer for someone with dysphagia than a thin liquid. Grilled or broiled fish is both easy to chew and nutritious. If you serve side dishes such as rice or potatoes, include a sauce to moisten them.
You can also make sure that the food on your friend’s plate is already cut into smaller pieces suitable to be grasped with the fingers or slipped into a spoon, and easier to chew. This can all be done quietly and without fanfare. No one will notice the extra steps you have taken, and your friend will have a more enjoyable -- and safer -- meal.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
