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Can Alzheimer's cause swallowing problems?

Dad is having problems swallowing and chokes a lot, is this part of the Alzheimer's progression?
Status: Open    Sep 05, 2014 - 08:18 PM

Dementia, Senior Health & Nutrition

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Expert Answers

Jun 01, 2016 - 10:35 AM

Unfortunately yes. Our brains help us perform voluntary movements, those things we think about doing like setting our alarm clock, laying out cloths for work, or following a recipe, and the involuntary movements like swallowing, blinking and breathing. As Alzheimer's progresses the brain eventually loses it's ability to send the signals our body needs to complete both voluntary and involuntary movements. In addition to choking, you may notice your dad holding food in his mouth. It is important to report this to the doctor and facility staff immediately, as this can lead to aspiration.

Jun 01, 2016 - 12:50 PM

Yes, Alzheimer's can cause swallowing problems. As the disease progresses, cognitive changes can result in feelings of overwhelm, disinterest, or confusion during mealtime. Moreover, neural changes can result in a less coordinated swallowing mechanism, in addition to diminished taste and smell, as well as changes in perception. All of these factors can contribute to eating and swallowing difficulty in a person with Alzheimer's.

Some tips to ensure safe eating and swallowing include: ensure the food or drink is not too hot, give the person plenty of time to eat at a slow pace, make sure the person is sitting in an upright position, minimize distractions during mealtime, have a simple table setting with only utensils the person needs, serve only 1 or 2 foods at a time to minimize sensory overload, have flexibility with food preferences, and eat together. You can also help pace your father if he seems to be eating too quickly, cue him to alternate each bite of food with a sip of liquid, and ensure he is not taking abnormally large bites. If he continues to have problems with choking or coughing excessively during meals, you should have him evaluated by a speech-language pathologist.

Jun 01, 2016 - 12:54 PM


Having trouble swallowing is considered to be a Geriatric Syndrome, meaning it can happen just as a result of the normal aging process, and is not directly associated with your Dad's Alzheimer's. The clinical term for difficulty swallowing is dysphagia, and can be divided into 2 types: Oropharyngeal and Esophageal. Oropharyngeal is difficulty swallowing, or coordinating movement of food or liquid from the mouth to the upper esophagus. This is the most common form, and two of the most common causes are stroke and Parkinson's Disease. Esophageal dysphagia is difficulty transporting food or liquid through the esophagus into the stomach. This type of dysphagia causes "dry" swallowing and is usually medication-induced. The 3 most significant consequences of dysphagia are: 1) Choking risk -From compromised cough, gag, swallow reflexes 2) Aspiration Pneumonia -Aspiration pneumonia can occur as the result of decreased coughing reflexes and the inability to clear the lungs of foreign remains. 3) Malnutrition. -Unplanned/substantial weightloss can be a sign of malnutrition. Make foods easier to swallow. For liquids you can add a product like Thick-It (available at some grocery stores and drug stores, or ask your pharmacy to special order) to the liquid. Thick-It will make it easier to swallow without changing how the food tastes. They also have a line of purees that can be a substitute for meals and/or snacks. Dysphagia can be assessed by a speech therapist/pathologist and an Ear, Nose, and Throat doctor. They can perform a Clinical Swallow Evaluation and determine if a Barium Swallow Test is necessary. A Barium Swallow test can pinpoint what the underlying cause of the dysphagia is so that it can be appropriately addressed and swallowing can improve. A Barium Swallow test can identify:
-Narrowing or irritation of the esophagus (for example, Schatski's ring) -Disorders of swallowing (dysphagia - difficulty swallowing), spasms of the esophagus or pharynx -Hiatal hernia (an internal defect that causes the stomach to slide partially into the chest) -Abnormally enlarged veins in the esophagus (varices) that cause bleeding -Ulcers -Tumors -Polyps (growths that are usually not cancerous, but develop into cancer) -Gastroesophageal reflux disease (GERD)
On a personal note, at 92 years old my grandfather was having difficulty swallowing, and a Barium Swallow Test identified a tumor and the return of throat cancer. He only lived a few more months after they figured out the cause of his dysphagia, becoming extremely malnourished in the process, despite having a feeding tube. I want to mention my personal story to stress the importance of identifying the underlying cause of your Dad's dysphagia.

In summary, I advise having a Comprehensive Medication Review to identify medications that are causing dysphagia or a decrease in appetiite- or any other symptoms he's having that is being caused by a medication. For example, side effects from medications commonly prescribed to seniors can cause confusion, trouble concentrating, delusions or even hallucinations, making their Alzheimer's appear worse than it actually is. If no medications can be identified, I would see an Ear, Nose, and Throat doctor and ask for a Barium Swallow test. Remain vigilant that he is properly nourished and eating enough food throughout the process. Pleas see the link in my profile to my website- I have a page that explains more about what a Comprehensive Medication Review is and why they are so benefical.

Source: "Geriatric Syndromes" for ASCP 2013. Nakia Beard, PharmD, and Trista Baily, PharmD, and

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