How Parkinson's Impacts Swallowing

Part 2: Seven Things I've Learned from Working with People with Parkinson's Disease. A Speech Pathologist's Perspective.

By Sophie Walsh, Senior Speech Pathologist

Part 1 explored the impacts of Parkinson's disease on speech, next we will explore swallowing.

3. Swallowing changes often go unnoticed

Another change that tends to fly under the radar is difficulty swallowing (dysphagia). Studies show that up to 80% of people with Parkinson’s may experience swallowing difficulties at some stage, often without realising it.

Swallowing involves over 30 muscles working in precise timing and coordination. When Parkinson’s slows down or disrupts those automatic motor sequences, subtle swallowing changes can occur. So how can you spot early swallowing issues? Here are some common early signs:

• Taking longer to finish meals

• Avoiding tougher textures

• Drooling (often misunderstood as excess saliva, but is actually due to reduced swallowing frequency related to that “dampened” motor initiation in Parkinson’s)

• More frequently clearing your throat or coughing during meals.

• Sensation of food sticking in the mouth or throat

• Needing water to “wash food down”

• Regular chest infections

• Weight loss or dehydration without clear cause

Early identification and support can make a big difference, and these changes don’t necessarily mean giving up favourite foods - they just mean taking a more mindful, supported approach. There are excellent strategies to reduce risk and keep eating safely and comfortably (more on that below). Additionally, just like with speech, there’s often a lot of benefit in proactive therapy for optimising and maintaining function for as long as possible.

4. Timing matters!

A helpful tip: time meals around your optimal medication window. Parkinson’s medications can improve muscle control and coordination, including the muscles used in swallowing. Eating and drinking during your medication “on” times can make mealtimes feel easier and smoother.

Here are some other practical tips that can make swallowing safer and more comfortable:

• Sit upright - sit fully upright at 90 degrees during meals and for at least 30 minutes afterward to help food go down smoothly and reduce the risk of aspiration (food going into the lungs instead of stomach).

• Take small bites and sips - use smaller utensils or cut food into smaller pieces. Take one sip or bite at a time.

• Avoid talking while eating - as social as meals can be, talking while chewing or swallowing increases the risk of food or drink “going down the wrong way” into the lungs.

• Double swallow - Swallow twice after each bite or sip to help clear any leftover food from the throat. A sip of fluid can assist with clearing any food residue from the mouth or throat.

• Stay alert and focused during meals - avoid distractions like TV or multitasking during eating. Concentration improves control and safety.

• Modify food textures if needed - if chewing or swallowing is becoming difficult, softer textures may be easier and safer to manage. A speech pathologist can guide this based on your individual needs.

• Don’t rush - allow extra time for meals. Rushing can increase the risk of food going “down the wrong way.”

• Keep your mouth clean - good oral hygiene helps prevent infections if food or liquid accidentally enters the lungs.

If you or a loved one is noticing any of the signs mentioned above, a referral to a speech pathologist for a swallowing assessment can offer tailored strategies, peace of mind, and tools to maintain independence for longer.

5. Breathing muscles matter, for more than just breathing

One of the most exciting developments in Parkinson’s therapy is the growing evidence behind respiratory muscle strength training (RMST) devices. These small, handheld tools are used to strengthen the muscles involved in breathing - but they do more than that.

Studies now show that training respiratory muscles can also improve speech and swallowing function, especially when used consistently. This is thought to be due to incidental strengthening of the small muscles involved in swallowing, speech and voice production when using these devices, as well a link between breath support, and speech and swallowing coordination. Some devices and associated programs are being increasingly recommended as part of a holistic speech/swallowing therapy plan, under the guidance of a speech pathologist.

Even just five minutes a day with these tools can bring noticeable benefits over time, making them a promising, low-cost, at-home strategy to support maintenance of these vital functions.