Top 5 ways to be proactive in preventing the leading cause of death for Parkinson's

Don Bolser at UF was recently interviewed about the importance of aspiration in neurodegenerative disorders.

Aspiration pneumonia (and pneumonia) has been cited by many papers and experts as the leading cause of death in Parkinson’s disease. There is a nice recent article in Nature about aspiration and Parkinson’s. What can you do to potentially prevent aspiration pneumonia in Parkinson’s disease? These are the practical strategies that I (Dr. Okun) use in my clinical practice. I would like to note that there is currently no standardized approach to this issue, so these are not the only suggestions— these are just my blog thoughts.

Expertinstitute.com has great information and images

Tip #1:

Recognize the warning signs of potential aspiration pneumonia.

Coughing when eating or drinking in the biggest warning sign. Choking when eating is another big one!

WebMD lists the following potential warning signs of aspiration:

Feel something stuck in your throat

• Hurt when you swallow, or it's hard to do

• Cough while or after you eat or drink

• Feel congested after you eat or drink

• Have a gurgling or "wet-sounding" voice when you eat

Other signs are:

• Too much saliva in your mouth

• Chest discomfort or heartburn

• Shortness of breath or fatigue while eating

• Fever within a half-hour of eating

• Frequent pneumonia

• Trouble chewing

Check out our article on cough and Parkinson’s in parkinsonsecrets.com

Tip#2:

Show off your cough at every clinic visit with your doctor.

For some unknown reason we do not frequently ask our persons with Parkinson’s to cough during the clinical evaluation. If the cough is noticeably diminished it should prompt a referral to the speech and language pathologist.

A person preparing for a swallow test in Hopkins swallowing center.

Tip #3:

Consider more frequent swallowing studies to screen for potential aspiration pneumonia.

Though not every person with Parkinson’s disease will require a swallowing study every year, it is important to ask the question— and in “at risk” folks, we need to be more liberal in seeking this evaluation. Your doctor and speech language pathologist can assess your risk—and can initiate prevention strategies if an issue is uncovered.

Image from US News

Tip #4:

Blow up a ballon.

I learned this trick from Dr. Emily Plowman at the University of Florida (and from one of the family members whose wife had ALS). This can be a great and easy was to both assess a person at risk for aspiration pneumonia, but also to exercise and strengthen the muscles needed to prevent aspiration pneumonia.

Great article in Neurology on EMST with the evidence.

Chris Sapienza, Danny Martin and Paul Davenport developed the EMST technology at UF.

Tip #5

Consider trying an Expiratory Muscle Strength Training Device (EMST).

There is class one evidence from a recent study by Drs Troche and Sapienza that daily use of this EMST device can potentially prevent aspiration pneumonia.

To read more books and articles by Michael S. Okun MD check on Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #Livingwith Parkinson’s #EndingPD #Parkinsonsecrets #LessonsFromTheBedside

He also serves as the Medical Advisor for the Parkinson’s Foundation.

To see more on Dr. Indu Subramanian she does live interviews of experts in Parkinson’s for the PMD Alliance.

The blog artist is Jonny Acheson.