Could my mother's gag reflex to water be dementia related?

Taka asked...

My 70 year old mother may be suffering from early/mid stage Alzheimer's. We are in the process of finalizing the diagnosis now. She is exhibiting a number of odd behaviors and physical "problems". One is that she says she can't swallow water because it makes her feel like she's going to gag. Could there be something mental about this related to the dementia? We are having a family appointment with a neuropsychologist tomorrow and will bring this up, but I'm really worried because she needs to drink more water but seems reluctant to do it. Any ideas?

Expert Answer

Lisa P. Gwyther, a social worker specializing in Alzheimer's services, is the author of The Alzheimer's Action Plan. An associate professor in the Duke University Medical Center Department of Psychiatry and Behavioral Sciences, she's also a past president of the Gerontological Society of America.

Your mother's gag reflex to water could be related to her dementia, but difficulty swallowing thin liquids like water is usually a more common symptom of the moderate to severe stages of dementia.  Regardless, it would helpful to have a swallowing study by a speech and language specialist.  Swallowing problems may indicate another medical condition as well. 

The swallowing study results should also suggest drink alternatives like thickened liquids or positioning changes like keeping her chin down near her chest when swallowing thin liquids.   (Of course, she may not remember these instructions). 

There are many ways to insure adequate fluid intake other than drinking water.  Some older people have reduced thirst mechanisms or physical sensations which would remind them to drink, and some people never liked to drink water.

On the other hand, behavior changes or changes in physical problems or complaints, as you mention, are common in the moderate stages of dementia.  People with memory disorders may get fixated on symptoms they believe are responsible for feeling "not like themselves" or symptoms which may have bothered them in the past.  She may "perseverate" about a problem with gagging, getting the idea stuck in her head.  Whenever anything bothers her, she may relate it to her gag reflex to water or to a physical symptom she had in the past which she recalls more easily than the present.  For example, some people consistently complain about pain they may have had many years before.  It may be more acceptable and less stigmatizing to complain about a physical problem than it is to complain about vague feelings of being lost or confused.  However, that doesn't necessarily mean they aren't in pain right now.

Because there are so many possibilities, begin by assuming she is correct about her recent onset gag reflex, and start with a swallowing study.  You want to give her every opportunity to insure adequate nutrition and fluid intake.