Expert: Mary Gordon - 9/29/2005

Question
Ms. Gordon...

From reading previous answers on the stages of alzheimer's, I believe my father who is 75 is in between stage 6 and 7. My concern:Lately, saliva collects in his mouth and he is not swallowing it or spitting it out. My mother is beginning to suction the saliva from his mouth. Is this another part of the progression of the disease? His inability to know when to swallow the saliva or spit it out?
Thank-You

Answer
The problems you describe are fairly common - sometimes a person will carry  saliva or food around in his mouth and not swallow it. This is due to forgetting how to chew or swallow (caused by a loss of muscular coordination from the brain damage that is called "apraxia"). The specific problem is called dysphagia - which is the 50 cent word for swallowing problems.

You and I produce saliva all day and reflexively swallow it - he may not be, thus appearing to have too much, and ending up drooling. You might also want to ask the doctor about it. I've heard it suggested that milk or citrus juices sometimes make the problem worse and other liquids might be better (other juices like cranberry), but I don't know if this works or not - might be worth trying.

If your dad is getting to the stage where chewing and swallowing are a problem, you will have to guard against choking and be careful what he is fed.  A close friend's mother in late AD actually choked to death last year - she was "chipmunking" food and the caregiver did not realize what she was doing (i.e. the caregiver was spooning the food into her mouth and the woman was not swallowing). My friend's mother then aspirated the food (banana pudding, if you can believe it) and died within a few minutes.

If your dad is having trouble swallowing, soft thick foods (chopped or ureed foods that are essentially thick liquids) are best. When he is fed, make sure he is sitting up straight with his head slightly forward, never tilted back. He should also stay sitting for 15 minutes after eating.  Don't feed him if he is sleepy or agitated. Foods with mixed textures can also be a problem (i.e. cereal with a liquid and a solid) because they may get confused about whether to chew or swallow. If a person tends to choke on thin liquids, try a thicker one. There are also commercial products that can be added to regular drinks such as Thick-It or Thick and Easy that can be purchased at many pharmacies that might help a lot (i.e. get him sipping the thickened liquid periodically and see if it makes him swallow the saliva as well).

This is something to talk over with the doctor as not only is it unpleasant, but aspirating saliva (or anything else) can be a serious problem for someone with Alzheimer's (i.e. its a common cause of pneumonia). Your doctor may send him for evaluation on tactics to deal with this - however, as it is part of the disease, it can't be fixed - just coped with.

Hope this helps. Best of luck with your dad. It really is a heartbreaking disease.  

Hope this helps

Mary Gordon
Toronto