Are coughing episodes and sensation of something stuck in the throat related to dementia?

Coughing Episodes and Throat Sensations in Dementia: Likely Due to Functional Globus Pharyngeus and Laryngeal Hypersensitivity

The nighttime coughing episodes and sensation of something stuck in the throat are most likely not directly related to dementia but represent functional globus pharyngeus with laryngeal hypersensitivity, which requires specific management focused on the throat symptoms rather than the dementia itself.

Understanding the Symptoms

The described symptoms show a pattern consistent with functional throat disorders:

• Nighttime coughing episodes that wake the patient from sleep
• Sensation of something "stuck in the throat" that has been worsening
• Episodes that resolve without further problems for the rest of the night

Relationship to Dementia

While dementia itself doesn't directly cause these symptoms, there are important connections:

• Patients with dementia, particularly Lewy body dementia, can experience decreased cough reflex sensitivity and deterioration in urge-to-cough perception 1
• Swallowing dysfunction can occur in dementia patients and may be associated with decreased respiratory function 2
• However, the specific pattern described (nighttime episodes, feeling of something stuck) points to a functional disorder rather than a direct dementia manifestation

Diagnostic Considerations

The symptoms align with two related functional disorders:

1. Globus Pharyngeus:

   • Presents as a sensation of a lump in the throat
   • Often described as something "stuck" in the throat
   • Can be persistent or intermittent
   • Associated with throat clearing and cough 3

2. Laryngeal Hypersensitivity Syndrome:

   • Manifests as chronic cough
   • Can occur without identifiable cause or persist despite medical investigation
   • Results from reversible changes in function or aberrant involuntary learned behaviors 3
   • Often worse at night or after meals 3

Management Approach

Immediate Assessment

1. Rule out medication causes:

   • Check if the patient is on ACE inhibitors, which can cause persistent cough 3
   • Review all medications for potential cough-inducing side effects

2. Evaluate for reflux:

   • The pattern of symptoms (nighttime episodes, sensation of something stuck) strongly suggests gastroesophageal reflux 3
   • Reflux-related cough typically improves when lying down due to closure of the lower esophageal sphincter 3

3. Consider swallowing assessment:

   • Given the dementia diagnosis, a modified barium swallow may be appropriate to assess for swallowing dysfunction 3
   • This is especially important if there are any signs of aspiration

Treatment Recommendations

For immediate management:

1. Elevate the head of the bed by 6-8 inches

   • This reduces nighttime reflux episodes that may trigger cough

2. Avoid eating within 3 hours of bedtime

   • Gastric distention from eating is a strong trigger for reflux and subsequent cough 3

3. Consider a trial of proton pump inhibitor therapy

   • Even without classic reflux symptoms, this may help if reflux is the underlying cause

4. Speech therapy referral

   • For assessment and management of potential globus pharyngeus and laryngeal hypersensitivity 3
   • Can provide techniques to reduce throat clearing and coughing behaviors

Special Considerations in Dementia

• Patients with dementia may have reduced ability to describe symptoms accurately
• Lewy body dementia in particular is associated with decreased cough sensitivity 1
• Monitor for signs of aspiration, as swallowing dysfunction can co-occur with dementia 2

Pitfalls to Avoid

1. Don't assume symptoms are directly caused by dementia progression

   • Treating the functional throat disorder can improve quality of life regardless of dementia status

2. Don't overlook medication side effects

   • ACE inhibitors can cause persistent cough that may take months to resolve after discontinuation 3

3. Don't miss aspiration risk

   • The sensation of something stuck could indicate dysphagia, which increases aspiration pneumonia risk in dementia patients

4. Avoid unnecessary sedating medications

   • Cough suppressants with codeine or other sedating properties may worsen cognitive function in dementia patients

By addressing these functional throat symptoms directly, quality of life can be significantly improved despite the underlying dementia diagnosis.