Seminal reviews stress the dangers of swallowing problems in people with Parkinson’s disease 

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Several recent publications focused on dysphagia and the importance of managing swallowing problems for patients with Parkinson (PwP). The links between timely medication intake and swallowing function are well known; this is emphasised in most of these publications.  The need for well-designed studies on swallowing intervention, considering the context (in- and out-patient) and the medication status, as well as other medical/behavioural/surgical therapies is also crucial. 

Below is a summary of two seminal studies on swallowing and PwP. 

A systematic Review of the Parkinson’s Foundation Hospital care recommendations 

This study reports on the results of a systematic review of the literature on the four major factors contributing to the increased morbidity and mortality during hospitalization of PwP.  

The most common reasons for hospitalization of PwP — estimated to cost $52 billion per year in the USA alone — are: aspiration pneumonia, urinary tract infections, psychosis, falls, fractures, and motor decline.  

PwP are usually admitted in hospitals without consistent care provided by a movement disorders specialist team. Compared to the general population of hospitalised patients, PwP face greater risk for complications and longer hospital stays. 

Four major factors contributing to increased morbidity and mortality during PD hospitalization were identified:

1. Medication timing: The authors highlighted the evidence of how detrimental even slight variations can be, with increased “off” periods, dyskinesias, and most importantly, exacerbation of dysphagia.  2. Harmful medications: The authors list the medication given during hospitalization that block dopamine receptors and can lead to complications.  3. Mobility: Hospital stays often lead to restricted mobility and rapid deconditioning.   4. Dysphagia: Hospital stays often increase the risks of silent aspiration and pneumonia. The links between dysphagia and medication swallowing are highlighted, as well as the documented link between dopamine and improved swallowing.

In conclusion, this is a seminal study on the risks from hospitalization of PwP from the Parkinson’s Foundation, which follows on the “Parkinson’s foundation hospital care recommendations” (2023) and could and should make a positive impact on PwP and the links between in- and out-patient care. 

Rehabilitation interventions for oropharyngeal dysphagia in people with Parkinson's disease 

In parallel, a Cochrane Library review provided a comprehensive review of the available evidence for the rehabilitation interventions for oropharyngeal dysphagia in PwP. They included 18 randomised control studies (1,216 participants) aimed at improving oropharyngeal dysphagia and with a main outcome measure of swallowing safety and swallowing efficiency. They found that “behavioral interventions, particularly EMST (Troche M et al 2010, 2023), may improve swallowing safety by reducing the risk of penetration and aspiration, but that the evidence is very uncertain. Large, well-designed placebo-controlled trials are required to assess the effectiveness of rehabilitation interventions for oropharyngeal dysphagia in PwP.” 

In conclusion, the ground is ready for a large, well-designed study on the holistic management of swallowing problems in PwP and the links with medication intake, hospitalization, and aspiration pneumonia. 

 

References 

1. Veilleux Carpentier A, Malaty IA, LeWitt PA, Azmi H, Brooks A, Pollak E, Air EL, Simpson H, Thomas J, Thomas FP, Cocoziello L, Rosenfeld S, Okun MS. A Systematic Review of the Parkinson's Foundation Hospital Care Recommendations. Mov Disord Clin Pract. 2026 Jan;13(1):29-43. doi: 10.1002/mdc3.70247. Epub 2025 Jul 30. PMID: 40736219; PMCID: PMC12839495.
2. Battel I, Arienti C, Del Furia MJ, Hirschwald J, Lazzarini SG, Walshe M. Rehabilitation interventions for oropharyngeal dysphagia in people with Parkinson's disease. Cochrane Database Syst Rev. 2024 Jan 26;2024(1):CD015816. doi: 10.1002/14651858.CD015816. PMCID: PMC10811748