Ask the expert: Is drooling an “overlooked” symptom of Parkinson’s disease?

As part of our ‘Ask the expert’ series, Belgium-based movement disorder specialist Dr Bruno Bergmans shares how sialorrhea, or drooling, can impact people with Parkinson’s physically and socially – and offers insights on potential support options

What drew you to work with people with neurological conditions like Parkinson’s?

I’ve always been intrigued by how the brain functions, in people with and without neurological conditions alike. I’ve always had the feeling that there is still a lot of research to be done in the field of neurology, and a lot of progress to be made.

I obtained my PhD at the Bart De Strooper Lab at VIB-KU Leuven in Belgium, focusing on neurodegenerative conditions. Now I run Parkinson’s clinic in AZ Sint-Jan Brugge-Oostende AV, a large hospital in Bruges, and work as an academic consultant at Ghent University Hospital, Belgium.

I enjoy my work because, although there are still many unmet needs in this area, I often feel I can really help people.

What is sialorrhea and how can it impact people with Parkinson’s?

No two people with Parkinson’s are the same – everyone has different symptoms.

Some people develop sialorrhea, which is sometimes called drooling. This is when people feel they have too much saliva in their mouth. Saliva dripping from the mouth can be very troublesome for people and their caregivers, and it can also be socially isolating. It becomes more and more evident in the later stages of the condition.

People associate Parkinson’s with tremors and trembling, but there are many other symptoms that can be challenging for people. I’ve found from working with my patients that sialorrhea is an overlooked symptom – people don’t talk about it enough. If you ask people specifically about it, you’d be surprised by how many are afraid to talk about it.

What have you found are the main challenges facing those who experience the symptom?

Sialorrhea can really have a huge impact on people. The main thing patients tell me is that they feel ashamed, and it affects their social interactions. They tell me that their grandchildren make comments about it, or they struggle with going to restaurants because they’re afraid other people will start looking at them, or they worry their neighbours in an apartment building will notice drops of saliva on the floor.

Because sialorrhea can also impact people who are still quite mobile, and whose motor symptoms are generally well controlled, these are people who would normally go to meet friends or go to a restaurant. But the symptom can be a problem that prevents it.

As a result, people experiencing sialorrhea might lose their self-confidence and their self-esteem. It can become a vicious cycle in which people are avoiding social contact, so they stay locked up in their home. And if people lose social contact, they become more isolated. This can also have negative effects on their cognition if they’re not stimulated intellectually.

Dr Bruno Bergmans.

What more do you think can be done to tackle the stigma around sialorrhea?

To be able to offer adequate treatment, I think it’s important that we educate people with Parkinson’s, caregivers and the general public about sialorrhea and its link to the condition.

I also think it’s very important for healthcare providers to create an atmosphere in their clinics where people feel that they can discuss any problems related to Parkinson’s with their doctor or nurse specialist. What can be helpful is to stimulate people and caregivers to ask questions.

Finally, management is key. If there are treatments that can help control the symptom, then people can worry less about the condition and focus more on their own self-confidence.

How can people living with Parkinson’s manage sialorrhea?

It’s important to realise that sialorrhea is a symptom of your Parkinson’s disease, and something can be done about it. There are ways of managing the symptom that can enable people to continue living life without having to worry about it.

Different medical treatments may help, which people should discuss with their physicians.

Speech and language therapy can also be an option to help manage sialorrhea. Swallowing is often a factor: where a person without Parkinson’s would swallow several times an hour to remove the saliva in their mouth, a person with more advanced Parkinson’s is less likely to do this automatically. Speech and language therapists can help with this.

Posture is also problem for many people with Parkinson’s, and if people are bent forward, they are also more prone to sialorrhea – physical therapy for this may help.

What advice do you have for people experiencing the symptom?

I would encourage anyone who is having challenges with sialorrhea to discuss it with their physician, healthcare provider, therapist and Parkinson’s nurse specialist – so that specific actions can be taken to improve the symptom.

This can help people to feel empowered. If they know that something can be done about it, they can also take some steps to help improve the symptom and to ask for help.

This article has been sponsored by Merz Therapeutics. The content of this interview was up to date and accurate at the time of interviewing in June 2022. The view expressed in this article represents the speaker’s own opinion and experience. The speaker may express personal opinions that are not necessarily shared by Merz Therapeutics. Content from this article has been reviewed by Merz Therapeutics.

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