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Dysphagia
can occur secondary to the use of tranquilizers implemented to control disruptive
or aggressive behavior in the elderly demented population. Dysphagia induced by
neuroleptics is uncommon but important to recognize because of its usual reversibility.
Nonetheless, resolution of neuroleptic-induced dysphagia may take several months
after discontinuation of the drug.
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Neuroleptics,
though considered equally efficacious in comparable doses, vary in potency and
adverse side effects. For example, low potency chlorpromazine has a low incidence
of extrapyramidal side effects (notably Parkinsonism) but often causes orthostatic
hypotension, sedation and xerostomia (dry mouth). High potency haloperidol, on
the other hand, has fewer anticholinergic side effects but is more likely to cause
extrapyramidal side effects.
In addition to xerostomia, which can interfere
with the oral preparatory phase of swallowing by reducing saliva production, neuroleptic-induced
Parkinsonism causes morbidity through the rigidity and bradykinesia is exerts
on the oral and pharyngeal phases of swallowing (42) (111). Specifically, oral
phase impairments include repetitive tongue pumping, lingual tremor and prolonged
oral transit time.
Effects on the pharyngeal phase include delayed initiation
of the swallow reflex, inadequate post-swallow pharyngeal clearance, silent aspiration,
prolonged pharyngeal transit time, incomplete laryngeal sphincter closure and
cricopharyngeal dysfunction.
Xerostomia, which may precipitate dysphagia
complaints, may also result from administration of anticholinergics, antihypertensives,
cardiovascular agents, diuretics, opiates, antipsychotics, antiemetics, antidepressants,
muscle relaxants and antihistamines (43) (112).
References
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Medications
