Early Stage Parkinson’s Disease

PWPD & SLP

Brenda Warren, M.A.,CCC-SLP

Speech-Language Pathologist

UNC Hospitals

Chapel Hill, NC

Four Main Areas of Focus

• Swallowing (Dysphagia)• Voice - Speech & Oral-Motor Function• Communication (verbal & non-verbal)• Cognition (Attention, Memory, Verbal

Fluency,Visuospatial Skills, Executive Function)

Swallowing(Dysphagia)

• 50% incidence rate• Generally emerges in later stages• Early indications

–Nighttime drooling–Difficulty swallowing pills–Decreased saliva

production(medications)–Sensation of food getting “stuck”

• Reflux

Quick Tips• Screening by SLP to obtain

“baseline” • Nighttime Drooling

–Elevate head slightly during sleep to restore gravitational pull

–Use absorbent pillow case (terrycloth,etc.) to keep moisture away from face

• Swallowing medications–Coat pills with olive oil–Tip head slightly forward–Sip water BEFORE attempting

pill–Take with a thicker liquid or semi-

liquid•Tomato juice, applesauce, etc.

Quick Tips

Voice-Speech & Oral-Motor Function

• 75-85% incidence rate over course of disease

• Often an early symptom related to PD– Decreases in

• Volume• Intonation (prosody)• Clarity (articulation)

– Increases in• Rate (hypokinetic dysarthria)

Quick Tips• Screening by SLP• Amplication Device• Lee Silverman Voice Training (LSVT)• Yacker Tracker or other objective feedback

device• Be sensitive to feedback from spouse, family,

friends, and colleagues– Phone– Noisy background*Consider hearing testing for both PD pt. and

partner

Communication(verbal & non-verbal)

• Frequently these symptoms emerge subtly in the early stages of PD and may increase in later stages–Difficulty with word finding–Masked face–Reduced eye-blink

Quick Tips• Screening by SLP• Keep distractions to a minimum during

conversation; give your full attention• Intentionally use words to describe your

feelings rather than relying on facial expression

• Alert your conversational partner to the fact that you are aware that your face is sending an “uninterested” signal

Cognition

• 40-60% incidence rate of impairment in at least 3 domains of cognitive function (not dementia)–Attention–Executive function–Visuospatial skills–Verbal fluency–Free recall–Personality change

Quick Tips

• Talk with MD/neurologist-referral for neuropsychological evaluation–Baseline data–Recommendations

•SLP for cognitive-linguistic therapy–Compensatory strategies

Questions