Drooling In Parkinsons Disease

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton

Introduction[edit | edit source]

Drooling in Parkinson’s disease (PD) is an many times disregarded however it is an important non-motor symptom that impacts the patient's quality of life, [1] having negative physical and psychosocial consequences for patients.[2] In relatively advanced patients with PD, drooling occurs in over 30% of patients, with dysphagia occurring with greater frequency in these patients[1]. The precise pathophysiological mechanism of drooling in PD is not clear, however excessive drooling is shown to be associated with higher burdens of non-motor symptoms and greater motor fluctuations of motor symptoms and bradykinesia[3].

Negative Effects[edit | edit source]

Drooling in patients may: cause saliva to spill from their oral cavity: may be aspirated causing aspiration pneumonia; may cause poor oral hygiene and, significantly, social embarrassment.[2]

Objective Measures[edit | edit source]

Problems with drooling may be addressed by a speech-language pathologist or physiotherapist.

Drooling screens include eg Radboud Oral Motor Inventory for Parkinson’s disease (ROMP)-saliva Assessment

Non-Pharmacological Treatment[edit | edit source]

A physiotherapist or speech therapist may offer treatments such as those listed below. These include:

  • Cues To Swallow, cue them to remember every eg 3 minutes to, such as commands like "gather your saliva in your mouth, tightly close your lips, then swallow".
  • Positioning. Posture is important in good swallowing. Work on preventing eg forward head posture which can increase drooling. Teach appropriate seating ergonomics and postural exercises[4].
  • Oral aides to assist swallowing eg chewing gum, sucking hard boiled lolly.
  • Use of sweat bands on wrist to discretely wipe away saliva.

Pharmacological Treatment[edit | edit source]

The first approach begins by removing medications that aggravate drooling eg. cholinesterase inhibitors, clozapine or quetiapine. Specific treatment options for drooling in PD are both pharmacological and nonpharmacological.

Pharmacological Treatments are mainly directed at reducing salivary secretion.

  1. Anticholinergics and adrenergic receptor antagonists work to decrease saliva production. Various administration methods eg injections, drops, or a spray that can dry the mouth
  2. Botulinum neurotoxin (BoNT). An injection of botulinum toxin is given into the salivary glands (cheek and jaw area) may reduce saliva production with minimal side effects. Side effects can include dry mouth, difficulty swallowing and weakness of the muscles in the jaw area. These injections can last up to three months (or longer) before needing to repeat injections. Botulinum toxin can be costly. Local injection with BoNT into major salivary glands is the most effective therapeutic option at present.

Developing more precise therapeutic choices would help to enhance patients’ quality of life.[2]

References[edit | edit source]

  1. 1.0 1.1 van Wamelen DJ, Leta V, Johnson J, Ocampo CL, Podlewska AM, Rukavina K, Rizos A, Martinez-Martin P, Chaudhuri KR. Drooling in Parkinson’s disease: prevalence and progression from the non-motor international longitudinal study. Dysphagia. 2020 Dec;35:955-61 .Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669801/ (accessed 9.11.2023)
  2. 2.0 2.1 2.2 Srivanitchapoom P, Pandey S, Hallett M. Drooling in Parkinson's disease: a review. Parkinsonism & related disorders. 2014 Nov 1;20(11):1109-18.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4252747/ (accessed 9.11.2023)
  3. Polychronis S, Nasios G, Dardiotis E, Messinis L, Pagano G. Pathophysiology and Symptomatology of Drooling in Parkinson’s Disease. InHealthcare 2022 Mar 11 (Vol. 10, No. 3, p. 516). MDPI.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8951596/ (accessed 9.11.2023)
  4. Adult Speech Therapy How To Assess and Treat Drooling in Parkinson’s Disease Available:https://theadultspeechtherapyworkbook.com/drooling-in-parkinsons-disease/ (accessed 9.11.2023)