What are abnormal mouth movements in the elderly?

Affecting a significant portion of older adults, abnormal mouth movements, or orofacial dyskinesia, can be a source of distress and health complications. With some studies indicating that up to 38% of the elderly may experience spontaneous dyskinesias, understanding what are abnormal mouth movements in the elderly is a critical first step toward diagnosis and effective management. This guide explores the causes, symptoms, and treatment options for this common concern.

Quick Summary

Abnormal mouth movements in older adults typically involve involuntary, repetitive actions like lip smacking, grimacing, and tongue protrusion, which can be symptomatic of conditions such as tardive dyskinesia (caused by long-term medication use), other neurological diseases, or even tooth loss.

Key Points

• Tardive Dyskinesia: A common cause of abnormal mouth movements is tardive dyskinesia, often resulting from long-term use of certain antipsychotic medications.

• Diverse Causes: Beyond medication side effects, other causes include spontaneous aging, neurological conditions like Parkinson's, and tooth loss (edentulous dyskinesia).

• Key Symptoms: Watch for involuntary actions such as lip smacking, chewing motions, grimacing, and tongue protrusion, which can negatively impact speech and eating.

• Impact on Quality of Life: These movements can lead to difficulties with eating, speaking, and socializing, causing significant distress and affecting overall health.

• Diagnosis is Key: A medical professional, often a neurologist, must properly diagnose the cause, which includes a full review of the patient's medication history and symptoms.

• Treatment Options: Management strategies range from adjusting medication to more advanced therapies like botulinum toxin injections or deep brain stimulation for severe cases.

Common Types of Abnormal Mouth Movements in the Elderly

Abnormal, involuntary movements in the mouth and jaw are medically referred to as dyskinesias. While they can occur at any age, they are particularly relevant in elderly care due to specific age-related factors and medication use. The most common forms include:

• Tardive Dyskinesia (TD): A long-term neurological side effect most often caused by the extended use of dopamine receptor blocking agents, such as antipsychotics or certain anti-nausea medications. TD is characterized by repetitive, involuntary movements primarily of the face, jaw, and tongue, such as lip smacking, grimacing, and rapid eye blinking.
• Spontaneous Orofacial Dyskinesia: Also known as senile chorea, this condition appears spontaneously in older adults without an obvious cause like medication. Movements can vary in intensity and frequency.
• Edentulous Dyskinesia: This type specifically affects elderly individuals who have lost their teeth (are edentulous). It is thought to be caused by a lack of sensory feedback from the ligaments that once supported the teeth, leading to involuntary jaw movements and chewing motions. Unlike TD, it typically does not involve tongue protrusion.
• Oromandibular Dystonia (OMD): A rare neurological movement disorder characterized by sustained muscle contractions in the face, mouth, and jaw. This can lead to involuntary jaw clenching or opening, lip pursing, and tongue spasms.

Causes and Risk Factors

Understanding the root cause is essential for proper management. Several factors contribute to the development of abnormal mouth movements in the elderly.

Medication-Related Causes

As mentioned, Tardive Dyskinesia is a major cause, linked to long-term use of specific medications, including:

• Antipsychotics: Both first-generation (e.g., haloperidol) and second-generation (e.g., risperidone) antipsychotics carry a risk, though the risk is higher with older, first-generation drugs.
• Anti-nausea Drugs: Metoclopramide is a common offender, especially with prolonged use.
• Antidepressants: While the risk is lower, some can contribute.
• Mood Stabilizers: Medications like lithium are a known, albeit less common, cause.

Neurological Conditions

Abnormal mouth movements can also be a symptom of underlying neurological disease:

• Parkinson's Disease: While characterized by slow movement and rigidity, some patients can develop dyskinesia, especially as a side effect of levodopa treatment.
• Other Movement Disorders: Conditions like Huntington's disease can also cause choreiform (jerky) movements that affect the facial muscles.

Other Factors

Other non-medication-related factors can also play a role.

• Aging: The simple process of aging is a significant risk factor for developing spontaneous orofacial dyskinesia.
• Tooth Loss: Edentulous dyskinesia is a direct result of losing teeth, which affects oral proprioception.
• Other Risk Factors: Being female and having a history of chronic psychiatric disorders or substance abuse are also associated with a higher risk.

Symptoms to Watch For

Recognizing the symptoms is key for early intervention. Abnormal mouth movements can include:

• Repetitive, involuntary chewing motions
• Lip smacking or pursing
• Grimacing or frowning
• Tongue protrusion or writhing
• Excessive blinking
• Puffing of the cheeks
• Jaw clenching or wide-open jaw spasms

Impact on Daily Life

These symptoms can have a profound impact on an older person's quality of life. They may lead to:

• Difficulty eating and swallowing (dysphagia): This can cause inadequate food intake and weight loss.
• Speech difficulties (dysarthria): Uncontrolled mouth movements can interfere with clear speech.
• Oral health problems: Biting the tongue or cheeks can cause ulcers, while excessive jaw movements can damage teeth or dentures.
• Social embarrassment and anxiety: The visible and uncontrollable nature of the movements can lead to social withdrawal and psychological distress.

Diagnosis and Management

Diagnosing abnormal mouth movements requires a thorough clinical assessment by a healthcare professional, often a neurologist. This involves reviewing the patient's medical history, including all current and past medications, and observing the movements.

Diagnostic Steps

1. Clinical Observation: A doctor will observe the type and pattern of the involuntary movements.
2. Medication Review: Assessing the patient's medication list for any potential culprits is a top priority.
3. Neurological Exam: A full exam can help identify underlying conditions.

Management and Treatment Strategies

Management depends on the cause. For medication-induced dyskinesia, the primary approach is to address the offending drug.

1. Medication Adjustment: The most important step for tardive dyskinesia is to reduce the dose, change the medication, or discontinue it altogether, under strict medical supervision. This should never be done abruptly.
2. Specific Medications: The FDA has approved specific medications, such as valbenazine and deutetrabenazine, for the treatment of tardive dyskinesia. Other drugs may also be used in some cases.
3. Botulinum Toxin Injections (Botox): For localized dystonia or dyskinesia, injections can temporarily paralyze or weaken the affected muscles, providing relief.
4. Deep Brain Stimulation (DBS): In severe, medication-resistant cases, a surgical procedure called DBS may be considered. It involves implanting electrodes in the brain to block abnormal nerve signals.
5. Multidisciplinary Approach: Other therapies, including speech therapy and occupational therapy, can help manage symptoms and improve daily function.

Comparison: Tardive vs. Edentulous Dyskinesia

Feature	Tardive Dyskinesia (TD)	Edentulous Dyskinesia (ED)
Cause	Primarily long-term use of dopamine-blocking drugs (e.g., antipsychotics).	Loss of teeth, affecting sensory feedback in the mouth.
Symptom Focus	Repetitive, involuntary movements of the face, tongue, and jaw. Can also affect limbs and trunk.	Stereotyped, chewing-like movements of the jaw and mouth, without tongue involvement.
Tongue Protrusion	Common. Often referred to as a "fly-catcher tongue."	Not typical. Movements are limited to the jaw.
Reversibility	Often irreversible, even after stopping the offending medication.	Sometimes improves with a well-fitting dental prosthesis.
Risk Factors	Older age, female gender, chronic psychiatric illness, history of substance abuse.	Older age, having lost all teeth.

Conclusion

Understanding what are abnormal mouth movements in the elderly is crucial for early detection and effective management. While often linked to medication side effects, they can also stem from other neurological issues or dental changes. Early recognition, careful medication management, and specialized treatment options offer the best chance for improving an individual's quality of life. Anyone observing these symptoms should consult with a healthcare provider to determine the cause and appropriate course of action. For more information on geriatric care and movement disorders, a resource like the National Institute on Aging website is an excellent starting point.

Frequently Asked Questions

Are all abnormal mouth movements in the elderly caused by medication?

No, while long-term medication use (especially antipsychotics) is a common cause, other factors can also be responsible. Conditions like spontaneous orofacial dyskinesia and edentulous dyskinesia are not medication-induced.

What is the difference between tardive dyskinesia and edentulous dyskinesia?

Tardive dyskinesia is a medication side effect that involves a variety of movements, including tongue protrusion. Edentulous dyskinesia is associated with tooth loss and is typically limited to chewing-like jaw movements without the characteristic tongue movements of TD.

Can abnormal mouth movements be reversed or cured?

For medication-induced cases, symptoms may improve after the offending drug is stopped or the dosage is adjusted, but they can be persistent or irreversible. Other treatments, such as Botox injections, can manage symptoms but are not a cure. An early and accurate diagnosis is essential for the best possible outcome.

What should I do if I notice these symptoms in an elderly loved one?

The first step is to consult their healthcare provider. Provide a complete list of their medications, including dosages and duration of use. A proper diagnosis by a medical professional, often a neurologist, is necessary to determine the cause and best course of treatment.

Do abnormal mouth movements worsen over time?

The progression of these movements depends on the underlying cause. In tardive dyskinesia, symptoms can develop and worsen gradually. For others, the movements may fluctuate. Proper management and treatment can help stabilize or reduce symptoms.

Can losing teeth cause abnormal mouth movements?

Yes, tooth loss can lead to a specific form of dyskinesia called edentulous dyskinesia. The lack of sensory input from the missing teeth can affect the involuntary movements of the jaw and mouth. In some cases, a new, well-fitting dental prosthesis can provide improvement.

What medications are most likely to cause tardive dyskinesia?

Long-term use of dopamine-blocking agents is the primary cause. This includes older-generation antipsychotics like haloperidol and some anti-nausea medications such as metoclopramide. While less common, certain newer antipsychotics and antidepressants can also be implicated.

Is botulinum toxin a viable treatment for abnormal mouth movements?

Yes, botulinum toxin injections can be an effective treatment for localized forms of dyskinesia or dystonia, providing temporary relief by blocking signals to the overactive muscles. A specialist typically administers these injections.