Dysphagia means difficulty swallowing.  It can develop in anyone, but more often it occurs in older adults, and the incidence of dysphagia increases when the patient also has Alzheimer’s Disease.  The process of swallowing may seem easy, and we don’t give much thought to it, but there are several steps involved.

In a normal swallowing process, food enters the mouth, and it is chewed properly.  Your tongue pushes it towards the throat.  The food then enters into the esophagus – the tube to your stomach.   An epiglottis acts as a door to block the trachea – the tube to your lungs – while leaving the door to the esophagus open.  Muscles in this area contract, pushing the food down into your stomach. 

Your esophagus and trachea lie right next to each other.  When the swallowing process isn’t working correctly, food and fluid can enter into the lungs and possibly result in aspiration pneumonia.  Patients with Alzheimer’s Disease may not be able to verbalize that they are having trouble chewing or swallowing so it’s important to be able to identify signs and symptoms.  

Signs & Symptoms

Coughing during or after eating and drinking

Increased saliva production during and after meals

Pain when swallowing

Change in vocal quality – voice sounds wet

Food falling out of the mouth or holding food in the mouth while eating or drinking

A sensation that food is getting stuck

Reflux or regurgitation

Taking a long time to eat

Weight loss

Dehydration or malnutrition

Diagnosis

Evaluation with a primary care provider or specialist

Swallow evaluation by a speech therapist

Imaging such as x-rays or video fluoroscopic swallow study

Endoscopy or pharyngoscopy

Treatment

Modifying consistency of foods (i.e. mechanically chopped, pureed)

Modifying consistency of liquids (i.e. nectar, honey or pudding)

Speech therapy

Esophageal dilation or surgery

Medication

Feeding tube for severe cases

Conclusion

Signs and symptoms of dysphagia may be subtle and go unnoticed.  Other times they may be pronounced. You might not realize a patient with Alzheimer’s Disease is having dysphagia, but they have repeated incidents of pneumonia.  This could indicate further investigation is warranted.  You may notice a decrease in appetite, dehydration or malnutrition.  These are also signs that dysphagia could be present.

It’s important to be able to identify signs and symptoms in patients with Alzheimer’s Disease. With proper diagnosis and treatment, the possibility of aspiration pneumonia and other negative effects of dysphagia can be reduced.  If you are concerned about possible dysphagia in your loved one, please contact the healthcare provider to discuss it further.  For more information about Alzheimer’s Disease and dysphagia, take a look at this systematic review.  If you need consultation for a loved one living with Alzheimer’s Disease, contact us.