Speech and swallowing changes can interfere with communication and eating, which can be isolating and harmful. Established programs and new treatment strategies may help strengthen voice and improve swallowing, boosting confidence and health.
Parkinson's disease (PD) can affect speech in several ways. Many people with PD speak quietly and in one tone, they don't convey much emotion. Sometimes speech sounds breathy or hoarse. People with Parkinson's might slur words, mumble or trail off at the end of a sentence. Most people talk slowly, but some speak rapidly, even stuttering or stammering.
Parkinson's motor symptoms, such as decreased facial expression, slowness and stooped posture, may add to speech problems. These can send incorrect non-verbal cues or impact the ability to show emotion. Parkinson's non-motor symptoms, such as memory or thinking (cognitive) problems also can affect speech. Cognitive problems, for example, may lead to difficulty finding the right words and slower speech.
Speech problems can make it difficult to communicate with family, friends and physicians. They also can interfere with a job (if you often give presentations, for example) and limit social interactions.
Parkinson's medication adjustments sometimes help with speech problems, but speech therapy typically is the main treatment. Parkinson's-specific programs, including Lee Silverman Voice Therapy (LSVT) LOUD and Parkinson Voice Project SPEAK OUT!, are led by certified speech therapists who teach exercises and techniques to improve the volume and clarity of speech. (SPEAK OUT! also includes memory-building exercises for those who have cognitive problems.)
Communication devices, which enhance or amplify speech, also may be helpful. These include personal microphones, touchpads and gadgets that prompt you to speak up if your voice volume decreases.
In Parkinson's, swallowing problems may cause coughing, choking or throat clearing when eating or drinking. Some people may feel like the food is getting "stuck" as it goes down.
To evaluate swallowing problems, doctors may order a test that takes x-rays while you swallow foods and liquids of different consistencies. This test shows where the swallowing problems are (the mouth or throat) and whether foods and liquids are going into the airway instead of the stomach.
Parkinson's medication adjustments may ease swallowing problems but usually don't resolve them. Swallowing therapy often is the main treatment, so your doctor may refer you to a speech and swallowing therapist. This specialist recommends exercises to strengthen swallowing muscles, as well as diet modifications such as thickening liquids. The therapist also may suggest behavioral strategies such as not using drinking straws; tucking your chin to your chest when swallowing; and taking smaller, slower bites when eating.
Since swallowing problems pose choking risks, your care partner may want to learn the Heimlich maneuver. It may never be necessary, but it can be life-saving.
In some cases, significant swallowing problems lead to weight loss because a person can't take in enough calories or adequate nutrition. In these situations, your doctor may raise the possibility of a feeding tube. This is a personal decision that should be discussed with your family and care partner, taking into account what you want for your care and quality of life now and in the future.
Some people with PD, especially those with swallowing problems or advancing disease, may experience drooling. People with Parkinson's swallow less often, so saliva builds up and can lead to drooling. This can be embarrassing and limit the desire to go out in public with friends and family.
Treatments may involve behavioral strategies and medications. Behavioral strategies include using sugar-free hard candy to stimulate swallowing and reminding yourself to keep your chin up and lips closed. The latter can be challenging, especially in advancing Parkinson's, when the head and chin may tilt forward and the mouth may automatically open at rest. Physical and occupational therapy may help with postural issues, such as the neck and shoulder stooping forward, which can worsen drooling.
Sometimes doctors prescribe medical therapies to treat drooling. Certain Parkinson's drugs, such as trihexyphenidyl — which can treat movement symptoms — can cause dry mouth as a side effect, which could help drooling. Because these drugs can cause many possible side effects, such as constipation, memory problems and sleepiness, especially in older people, their potential benefits must be carefully weighed against the risks. In some cases, other therapies are prescribed to target drooling. These may include drugs, such as Robinul (glycopyrrolate), or injections of Xeomin (incobotulinumtoxinA) or Myobloc (rimabotulinumtoxinB) into the salivary glands.
Speech and swallowing problems can significantly impact the lives of people with Parkinson's and their care partners. Better treatments are urgently needed. Researchers are testing varied therapies, including exercises for voice, swallowing and breathing muscles; group singing programs; and non-invasive brain stimulation. They're also looking at lower levels of deep brain stimulation (DBS) to treat Parkinson's motor symptoms without worsening speech or swallowing problems, as these can be a side effect of DBS.
As researchers work toward better therapies, they look to a deeper understanding of these symptoms. Some are analyzing the speech patterns of people with Parkinson's, for example, to see whether speech changes could be used to diagnose disease. The Michael J. Fox Foundation for Parkinson's Research (MJFF) also is gathering data about these and other symptoms through its online clinical study Fox Insight. Register today to contribute valuable information through questionnaires and surveys on your medical history.
Visit MJFF's study-matching tool Fox Trial Finder to learn more about ongoing trials.