Pain related to parkinsonism often responds to adjustment of antiparkinsonian medications. Other causes for radicular pain and neuropathy need to be evaluated when appropriate. Swallowing abnormalities include abnormal lingual control and inability to pass a bolus of food backward into the pharynx. Silent aspiration with repetitive reflux of food from the vallecula and pyriform sinuses into the oral cavity are a significant problem. Retention of food and pills in the vallecula are another contributory cause of erratic levodopa absorption, and therefore, a secondary cause of dysphagia.
Soft diets help most types of dysphagia by making it easier to move food in the mouth and esophagus.
Soft food also decreases aspiration by reducing the need for separate liquid intake, since liquids often cause more aspiration than solids. Coal tar shampoos can be used not only for dandruff but also for seborrhea over the eyebrows and forehead. They should not be used more than once or twice weekly Selenium-based shampoos also work in some patients when used in a similar manner. Topical hydrocortisone is most effective on the face but needs to be applied daily. The causes of falls in the elderly are usually multifactorial and can be divided into intrinsic and extrinsic factors.