Tuesday, April 23, 2024

Is Drooling A Sign Of Parkinson’s Disease

Management Of Saliva Flow

Drooling in Parkinson Disease with AQ Rana MD Neurologist

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.

What Is The Outlook For Persons With Parkinsons Disease

Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.

Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.

The future is hopeful. Some of the research underway includes:

  • Using stem cells to produce new neurons, which would produce dopamine.
  • Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
  • Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.

Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.

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.

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Prevalence Associated Factors And Negative Impacts Of Drooling In Pd

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 .

How Is Parkinsons Disease Diagnosed

Parkinsons &  Drooling

Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.

To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.

If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.

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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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Role Of Saliva In Health And Well

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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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.

Normal Physiology Of Salivation And Swallowing

Vlog #121 – Drooling In Parkinson’s Disease

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 .

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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 .

What Are The Surgical Treatments For Parkinsons Disease

Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.

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What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

Embarrassing Symptoms Of Parkinson’s Disease

Drooling And Eating Problem in Parkinsons Disease by PD ...

Some symptoms that may occur in people with Parkinsons disease are not typical of it and so people noticing them may misunderstand them. These symptoms can be particularly embarrassing in social situations where other people witness their discomfort. They distress some people so much that they avoid company other than close friends or family. Most of these symptoms are caused by Parkinsons but some are side effects of the medicines used to treat it. All the symptoms tend to fluctuate in relation to the medication, and some people had learnt to adjust their medicine regime to minimise these effects.

Eating can cause embarrassment in several ways. Both tremor and dyskinesia affect the physical job of cutting up food and directing it into the mouth . Several people had a problem with a piece of steak or chicken that might fly off the plate as they tried to cut it up, or they had a choking fit if they unwisely took too big a piece into their mouth. Humphrey disliked eating out with friends because he tended to drop things.

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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.

Eating Swallowing And Saliva Control

Some people with Parkinsons may find they have problems with eating, swallowing and controlling their saliva.

This information looks at the issues you may face, explains why they happen and what help is available.

Eating is a social activity and problems that affect chewing and swallowing can have a big impact on how much you enjoy meal times. For example, some people with Parkinsons have told us that they feel self-conscious or embarrassed while eating because of their symptoms.

Its important to look out for symptoms related to difficulties with eating and swallowing. These can develop slowly over time and you may not notice them, so family, friends or carers should know what to look out for too.

If youre not able to swallow properly, you may experience:

  • drooling
  • inability to clear food from the mouth
  • food sticking in the throat
  • a gurgly voice
  • coughing when eating or drinking
  • choking on food, liquid or saliva
  • problems swallowing medication
  • discomfort in the chest or throat

These things can lead to a number of long-term problems, including:

Talk to your GP as soon as you can if you have problems with eating or swallowing they may refer you to specialists who can help.

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Treatment Options For Drooling In Pd

First, treatment should begin by withdrawing medications that aggravate drooling such as cholinesterase inhibitors, clozapine or quetiapine. Next, the target might be to improve motor symptoms by using dopaminergic medications or by performing deep brain stimulation if the motor symptoms otherwise justify these approaches. However, the response of drooling is usually only partial and there is clearly a need for a specific adjunctive treatment for this problem. Specific treatment options for drooling in PD are both pharmacological and nonpharmacological.

Botox For Excessive Drooling

I have problems with drooling due to Parkinson’s Disease. What can I do about it?

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.

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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

Eating Swallowing And Saliva Management

Some people with Parkinsons may find they have difficulties with eating, swallowing and saliva control at some stage of their journey with Parkinsons.

Parkinsons can cause the muscles in the jaw and face to become stiff which affects the control of chewing and swallowing.

Another symptom of Parkinsons can be producing excessive saliva. The stiffer facial muscles can change the nature of saliva, which may become thicker and stickier.

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