Swallowing is a serious issue that patients with brain disease often overlook

Millions of people suffering from brain diseases such as Alzheimer’s and Parkinson’s Disease, Lou Gehrigs’ disease, strokes, multiple sclerosis, and traumatic brain injuries have difficulty swallowing. They are, therefore, unable to protect the lungs as well as a healthy individual.

Millions of patients with brain diseases are at risk of inhaling saliva and food into their lungs. This can lead to pneumonia or even death.

It is crucial to detect and treat impaired swallowing, especially as America’s 70 million baby boomers continue to age. Impaired swallowing can be associated with a variety of elderly conditions but is frequently underreported. Clinicians might not notice it, or they may think it is a side-effect of another state.

As a neuroscientist with experience in brain diseases, I am not aware of any pharmaceutical companies that have programs to discover drugs that restore weakened swallowing and cough. It’s still a big problem.

Easy to choke, hard to swallow

The larynx must be completely closed while the food moves through the throat. Dysphagia is a disordered way of swallowing that limits the ability of muscles in the throat and mouth to carry food or liquids into the esophagus and then to the stomach.

The risk of pneumonia and choking increases when the airways or lungs are not protected.

Many people with brain disorders also experience reduced coughing or a weaker ability to activate breathing muscles to create airflows to eject materials from the lungs. The brain or nerves that detect foreign materials in the lungs can cause a weak cough.

Problems with the nerves of the neck can also cause disordered swallowing. People with cancer in the neck or head may undergo extensive surgery to remove diseased tissue. Inadvertently, this process can damage nerves important for swallowing.

Sometimes the primary brain disorder is not the cause of death but the impairment in swallowing. If swallowing is impaired, it is more probable that food or liquid will enter the lungs or trachea when eating or drinking. Aspiration is the term used to describe this. Aspirated food and drink coat the lungs with pathogens. These pathogens, which are normally not present in the lungs, can cause serious episodes of pneumonia and chronic inflammation.

A weak cough can be a sign of a serious illness.

Patients with acute stroke have severe swallowing and coughing impairments at the same time. In our research, we found that a weakened cough can predict the risk of aspiration caused by swallowing impairment in stroke and Parkinson’s disease patients. These findings show that brain disorders can cause multiple impairments to how we protect airways.

This problem can be viewed as a system of tools or reflexes that the nervous system uses to accomplish certain tasks. Each reflex is assigned a function, and the brain coordinates when each one occurs to maximize the result.

A cough, for example, can cause material to be ejected from the airways and into the throat or mouth. Swallows are often performed immediately after coughs in order to move the material that has been deposited in the throat up into the esophagus and finally into the stomach. Coughing cleared the lungs, and swallowing removed any material that was left in the throat.

Nearly half the residents of long-term facilities are susceptible to pneumonia.

Patient in a facility for care. Via Shutterstock. Via www.shutterstock.com

Aspiration is increased when there are simultaneous impairments in the ability to cough and swallow. This is because the pathogens in the lower airways can increase the risk of pneumonia. Aspiration pneumonia has been associated with mortality rates exceeding 60%, resulting in a US$4.4 Billion medical burden for patients hospitalized alone in 1997. Aspiration pneumonia can cost as much as 17,000 for each hospital admission. This type of pneumonia may affect up to half of residents in long-term care facilities.

Everyone has a story to tell when members of our team discuss airway protection with their friends. The stories are usually about an older relative with a brain disorder who was having difficulty eating. They often found that their relatives choked or were forced to eat thick food. This is a sign of impaired swallowing, coughing, and aspiration.

They are experts in the diagnosis and treatment of swallowing disorders. They recommend foods that are thicker and easier to chew. This is the clinical approach that is most widely accepted.

Some companies sell devices that use a weak electric current on the neck in order to improve swallowing. Controversy surrounds the long-term benefits of these devices. These therapies also haven’t been proven to improve a weak cough reflex.

No drugs are available to treat impaired swallowing or cough. The pharmaceutical industry does not recognize the importance of the prevention of aspiration for patients with neurological diseases.

A Japanese team has developed a protocol that uses sensory stimuli, such as capsaicin and menthol, the spicy ingredient found in red peppers, to assist older adults with serious impairments when swallowing. Their preliminary results show that these patients have reduced their aspiration pneumonia.

A promising approach, based on strengthening the breathing muscles, has been shown to improve swallowing and coughing function in patients with Parkinson’s disease or stroke. The approach is known as “expiratory muscles strength training” and is simple for both health care providers and patients. At this time, it is not known how well this method will prevent pneumonia among at-risk patients.

While there are promising treatments, they are not widely accepted for patients who are at high risk of aspiration. Research on the neurological mechanisms that govern coughing and eating will help to develop new treatments for aspiration pneumonia.