PD Blog Series 2. Swallowing Impairments in Parkinson's Disease: The Impact on The Three Phases of the Swallow

by Reva Barewal February 24, 2025

Swallowing difficulties, also known as dysphagia, are a common yet often overlooked complication of Parkinson’s disease (PD). These challenges can affect any or all three phases of swallowing: oral, pharyngeal, and esophageal. Understanding the signs and implications of dysphagia in PD is essential for ensuring safe eating and maintaining quality of life.

The Three Phases of Swallowing and How Parkinson’s Disease Affects Them

1. Oral Phase: Preparing the Food for Swallowing

The oral phase involves chewing and moving food or liquid to the back of the mouth in preparation for swallowing. In Parkinson’s disease, muscle rigidity and impaired coordination can cause:

Tongue pumping or rocking – repetitive, non-propulsive tongue movements that make it difficult to move food efficiently.
Poor bolus formation – difficulty gathering food into a cohesive mass for swallowing.
Oral residue – food remaining in the mouth after swallowing due to weak tongue pressure.
Anterior spillage – food or liquid leaking from the lips due to reduced lip closure.

These issues can make eating a frustrating and prolonged process, leading to reduced food intake and potential malnutrition.

2. Pharyngeal Phase: Moving Food Through the Throat

Once food leaves the mouth, it enters the pharyngeal phase, where it travels down the throat while the airway is momentarily closed to prevent aspiration (food entering the lungs). In PD, common challenges include:

Delayed swallow initiation – hesitation before swallowing, increasing the risk of food entering the airway.
Reduced hyolaryngeal excursion – weakened elevation of the voice box, making it harder to protect the airway.
Decreased pharyngeal contraction – weak throat muscles leading to food residue and possible choking.
Impaired airway protection – reduced cough reflex and delayed airway closure increase the risk of aspiration pneumonia, a leading cause of hospitalization in Parkinson’s patients.

Research has shown that patients with PD often have impaired cough responses, making silent aspiration (when food enters the lungs without triggering a cough) a serious concern.

3. Esophageal Phase: Transporting Food to the Stomach

The esophageal phase begins once food passes through the throat and enters the esophagus, the tube that carries food to the stomach. In Parkinson’s disease, esophageal dysfunction can include:

Weak peristalsis – reduced wave-like muscle contractions that move food down the esophagus.
Incomplete bolus transit – food getting stuck, leading to discomfort and potential regurgitation.
Upper esophageal sphincter (UES) dysfunction – difficulty with the opening and closing of the valve between the throat and esophagus, contributing to swallowing discomfort and reflux symptoms.

Studies indicate that esophageal motility issues occur in up to 95% of individuals with PD, making early assessment and management essential.

Why Early Detection Matters

Dysphagia in Parkinson’s disease can lead to serious complications, including:

Malnutrition and dehydration due to difficulty eating and drinking.
Aspiration pneumonia, a life-threatening condition resulting from food or liquid entering the lungs.
Reduced quality of life, as mealtimes become stressful and social isolation increases.

How Caregivers and Healthcare Providers Can Help

Monitor for signs of dysphagia – coughing while eating, prolonged meal times, unexplained weight loss, or frequent throat clearing may indicate swallowing difficulties.
Encourage a swallow evaluation – speech-language pathologists (SLPs) can conduct assessments such as a videofluoroscopic swallow study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) to determine the severity of dysphagia.
Modify food and liquid textures – using transitional foods, such as dysphagia-friendly snacks, can make swallowing safer and easier.
Implement safe swallowing strategies – posture adjustments, pacing techniques, and targeted exercises can improve swallowing function.
Stay proactive – routine swallowing assessments and collaboration with speech therapists and dietitians can help prevent complications before they become severe.

Conclusion

Swallowing difficulties in Parkinson’s disease are complex but manageable with the right support and early intervention. By recognizing the signs of dysphagia and seeking professional guidance, caregivers and healthcare providers can play a crucial role in enhancing safety, nutrition, and overall well-being for individuals living with PD.

For more information on dysphagia management and transitional food solutions, visit our store.