The Leading Cause of Death for People with Parkinson's Disease

Aspiration pneumonia, which is often caused by a swallowing problem, also called dysphagia, is the leading cause of death for people with Parkinson's disease. When caught early and treated early, many hospitalizations and deaths could be prevented. Most people have never even heard of dysphagia, but it is a very dangerous problem which affects up to 90% of people with Parkinson's Disease. 

I am a speech language pathologist who has been working with people with Parkinson's Disease for many years. I have worked mostly in home health care. I've been amazed over the years by how many times I have been sent to see a patient for slurred speech, low volume voice, memory problems, or word finding problems only to find out upon further evaluation that the patient has dysphagia and is at high risk of getting aspiration pneumonia which is the leading cause of death for people with PD! Nobody even suspected it. Not the doctor, not the nurse, not the patient, nobody. This has happened to me so many times. It makes me really wonder how many more patients are out there with this problem, who don't ever even know that's what is killing them, or that it probably could have been prevented with appropriate detection and treatment.

It is hard to detect dysphagia, because even the patients usually do not notice the problem. Dysphagia is a disorder of the swallowing mechanism. I always ask my patients if they are having any trouble swallowing, and they ALWAYS say "NO". Then, when I ask them more questions about it, like "Do you cough or clear your throat when you eat or drink?", "Do foods or pills get stuck in your throat?", or "Does your voice sound gurgly during meals?", then they start telling me about those problems and we find out they actually do have a swallowing problem! They just didn't realize those symptoms were related to their swallowing. Or, they may have had those symptoms for a very long time and they haven't noticed as they have very gradually  become more frequent or more severe until what was initially an occasional nuisance has now evolved into a very dangerous problem. Plus, in about half of the cases, people have lost sensation in the swallowing mechanism and don't feel any problem at all, and may show little or no symptoms, even when they may have a very serious case of dysphagia.  

If you or your loved one have Parkinson's Disease, I highly recommend you find a speech language pathologist who specializes in dysphagia and request a screening or an evaluation. Hopefully one day it will be an automatic protocol upon diagnosis and perhaps annually thereafter. In the care of a good speech language pathologist, many cases of dysphagia can be reversed, and at the very least, they can be managed to dramatically decrease the risk of aspiration pneumonia, choking, and death due to this problem.

About the Author: Jolie Parker, M.S.CCC-SLP is a speech language pathologist who specializes in the treatment of dysphagia for adults with Parkinson's Disease, stroke, Alzheimer's Disease, Huntington's Disease, traumatic brain injury, and Multiple Sclerosis. She is a co-inventor of the ISO Swallowing Exercise Device and she is the author of the ASHA approved continuing education course for speech language pathologists: Using the ISO Swallowing Exercise Device in Dysphagia Therapy (

Make Pureed Foods and Thickened Liquids Taste Good!

As a speech-language pathologist, I have empathized with my dysphagia patients over the years as I watched them struggling to eat and drink pureed foods and thickened liquids which appeared very unappetizing. I listened to their complaints and tried to imagine how awful it would be to be on a modified diet like that. I heard comments frequently like "It has no taste." or "It tastes terrible."

Many of my patients lost weight while on modified diets because they would rather not eat at all than eat that stuff, and some of them would refuse to follow the physician's orders and risk getting aspiration pneumonia or choking rather than being restricted to foods and liquids they couldn't enjoy.

My heart broke for them. I wanted to help them get better and I wanted to make the modified diet taste better so that they could still enjoy life until they did get better. Along the way, I have discovered a few things that can really improve the taste of thickened liquids and pureed diets.

My favorite trick is to mix a pudding cup with a glass of cold milk. It mixes pretty easily with a spoon, or you can put it in the blender. This makes a great tasting thickened liquid, with no Thick-It needed! You can adjust the thickness by the amount of pudding and milk you use. For thicker consistency, use more pudding, and to make it thinner, use more milk.

Another favorite of mine is to mix applesauce with juice to create a thickened liquid that tastes very good. Just like with the pudding, you simply adjust the amount of applesauce to create the thickness you need. Occasional stirring is needed for the apple sauce and juice if you don't drink it right away. It tends to settle at the bottom of the glass if it is left sitting for a while, which makes the liquid at the top of the glass too thin. So make sure it is stirred well at all times and enjoy!

For pureed food, the problem is that when you put foods in the blender and add liquid so that it will blend into a puree, the liquid dilutes the taste, leaving foods tasting very bland and unappealing. This is an easy problem to fix. For meat dishes, add a spoonful of Better Than Bouillion, chicken or beef flavor as appropriate. This stuff tastes so good you won't even care that it's pureed! You can also add it to mashed potatoes, rice, noodles, and vegetables when you puree them in the blender.

It's also great to give dysphagia patients who are on pureed diets or thickened liquids foods and drinks which are "normal" pureed or thick liquids for everyone, such as: mashed potatoes, mashed sweet potatoes, devilled ham, tuna fish mixed with mayonnaise, apple sauce, yogurt, pudding, instant oatmeal, cream of wheat, grits, and fruit smoothies. These foods are familiar, which is very comforting for dysphagia patients.

Milk shakes, ice cream, sherbets, and sorbets at first glance seem to be good pureed or thick liquids, but they actually melt when they make contact with your warm mouth and become thin liquids which can be very dangerous for dysphagia patients. By adding a thickener, such as Thick-It to them and mixing it in with a spoon or a blender, in the same proportions you would with the same quantity of thin liquids, you easily convert these tasty treats into pureed dishes or thickened liquids.

Soups are another great option for people on pureed diets. You can take any can of ready to eat soup and pour it in the blender, mix it up, heat it up, and it becomes a quick and easy honey thick liquid or pureed soup that tastes great. If you want to spend more time, making homemade soups, the possibilities are endless! You can make cream of potato soup, tomato soup, broccoli cheese soup, cream of mushroom soup, and cream of chicken soup, just to name a few. As long as the end product is thick and smooth by putting it through the blender, use any soup ingredients you like to make a variety of options.

Nothing is better than fully recovering from dysphagia, but these ideas and suggestions will hopefully make the road to recovery more pleasant so that you can have a little fun on your way there.

Jolie Parker, MS CCC-SLP is a speech-language pathologist with over 19 years experience who specializes in dysphagia rehabilitation. She is co-owner of Alternative Speech and Swallowing Solutions, co-inventor of the ISO Swallowing Exercise Device, and co-owner of Baseline Medical Services, a speech therapy clinic and home visit service, located in Altamonte Springs, FL. She is a current ASHA member.