Dad lost his swallow ability, then suddenly regained it back. What's going on?

Desireen asked...

My dad has frontal temporal lobe dementia. About 5 days ago he "lost his ability to swallow". The doctors did a barium test and he aspirated and got pneumonia. He was in ICU for maybe 2 days, then they sent him to hospice. We asked for a 2nd swallow test to be sure but the doctor said no...that he was at the end of his illness and it would do no good. Today, the nurses decided to try a bit of juice which he indeed swallowed. They next tried food. He ate a large amount of soft foods such as mac and cheese, green beans, a fruit cup, and tapioca pudding. What do we make of that? Was the swallow test wrong? Is he able to swallow again? Does the ability to swallow go in and out in the final stage of dementia before it sets in permanently? Another nurse is saying that it probably all went down the wrong tube into his lungs. However, wouldn't he cough and choke immediately with that large amount of food entering his lungs? Really, what can be going on here?

Expert Answer

Ladislav Volicer, M.D., Ph.D., is recognized as an international expert on advanced dementia care. He is a courtesy full professor at the School of Aging Studies, University of South Florida, Tampa, and visiting professor at the Third Medical Faculty, Charles University, Prague, Czech Republic. Twenty-five years ago, he established one of the first dementia special care units.

Your experience just shows the danger of baryum swallow test, which in my opinion is not useful in a progressive dementia like your father has. Difficulties swallowing are common in advance dementias but the problem may be different on different days. You describe clearly that your father can swallow now. Baryum milk is a foreign substance that may be aspirated more readily than regular food and liquids. Baryum swallow test does not provide good information what is happening during eating regular food and liquids. Let you father enjoy his food and liquid as much as he can without additional tests. He may sometimes start choking and aspirating but there is no good way to prevent it completely. Even if you considered tube feeding, that would not prevent aspiration pneumonia, because it does not prevent aspiration of saliva that have many more microbes than food and liquids. It is important to keep mouth of your father clean, and teeth and gums in good condition to prevent growth of dangerous bacteria in his saliva. There are also some medications that may decrease aspiration by promoting cough reflex but they may have some side effects.