Swallowing Problems in People with ALS, Other Brain Diseases Often Overlooked

Swallowing problems are common in people with brain diseases like amyotrophic lateral sclerosis (ALS) and Alzheimer’s disease and can cause severe complications such as pneumonia or even death by choking. But these problems are often overlooked by clinicians, researchers caution.

An opinion piece titled “A serious and often overlooked issue for patients with brain diseases: Swallowing,” by Dr. Donald Bolser, a professor at the University of Florida recently published in the independent news and views website The Conversation, highlights the importance of detecting and treating impaired swallowing in people with brain diseases.

“As a neuroscientist who has studied brain diseases, I know of no pharmaceutical companies that have drug discovery programs aimed at restoring weakened swallow and cough,” Bolser writes. “And yet, it’s a major problem.”

Swallowing is achieved by the complete closure of the larynx, or voice box, during the movement of food or liquids down the throat. If swallowing is impaired due to brain disease, the airways and lungs cannot be protected from food or liquids and this can result in choking or lung infections such as pneumonia.

According to Bolser, sometimes it is the swallowing impairment itself that leads to death rather than the brain disease. This emphasizes the importance of tackling swallowing problems in people with brain disease.

According to a review article, it is estimated that pneumonia caused by food and liquid entering the lungs and trachea during eating or drinking, also known as aspiration, costs as much as $17,000 per hospital admission.

Currently there are no drugs available to treat impaired swallowing.  “It appears that the pharmaceutical industry has not yet recognized the importance of prevention of aspiration in patients with neurological disease in disease outcome,” Bolser writes.

The most common clinical approach to swallowing impairments in people with brain disease is the recommendation to consume thick foods that are easier to swallow.

There are also some devices available that apply a weak electrical current to the neck to improve swallowing. However, the long-term effect of these devices is not clear.

Other than that, a team in Japan developed a comprehensive protocol in promoting swallowing in elderly people using menthol and capsaicin, the active ingredient of chilly pepper. The preliminary results of this method showed “impressive improvements” in pneumonia caused by aspiration.

Finally, an approach called “expiratory muscle strength training,” based on strengthening breathing muscles has been shown to improve swallowing in people with neurological problems such as Parkinson’s disease and stroke. However, it is currently not known how beneficial this approach can be in preventing pneumonia in people with swallowing difficulties.

“While there are some promising approaches, there are no widely accepted therapies for restoring weakened swallow and cough in patients at significant risk of aspiration,” Bolser concludes. “Continued research on the fundamental neurological mechanisms of coughing and swallowing will provide a foundation for new therapies to reduce the occurrence and severity of aspiration pneumonia.”