What causes an elderly person to move their tongue around?

According to the National Institutes of Health, tardive dyskinesia (a common cause of this symptom) may affect a significant portion of patients on certain long-term medications. Understanding what causes an elderly person to move their tongue around is crucial for proper diagnosis and care.

Quick Summary

Involuntary tongue movements in seniors often indicate an underlying neurological issue such as tardive dyskinesia, a side effect of long-term medication use. Other potential causes include neurodegenerative diseases, oral health problems, or idiopathic conditions that require careful medical evaluation.

Key Points

• Tardive Dyskinesia: Often the primary cause, linked to long-term use of certain psychiatric and anti-nausea medications.

• Medication Side Effects: Several non-psychiatric drugs, including some antidepressants, can also trigger orofacial movements in seniors.

• Oral Health Issues: Lack of teeth (edentulism) or poorly fitting dentures can disrupt sensory feedback, leading to involuntary tongue movements.

• Neurodegenerative Diseases: Underlying conditions like Parkinson's or Huntington's disease can manifest as involuntary movements affecting the tongue.

• Diagnosis is Key: A thorough medical evaluation by a healthcare provider, often a neurologist, is essential to determine the specific cause and rule out other conditions.

• Treatment is Targeted: Management options range from adjusting current medications to specific therapies like valbenazine or botulinum toxin injections, depending on the cause.

Primary Cause: Tardive Dyskinesia (TD)

One of the most common and well-documented causes for involuntary oral movements in the elderly is tardive dyskinesia. This is a neurological side effect resulting from the long-term use of certain medications that block dopamine receptors in the brain, particularly older antipsychotic drugs. These medications are used to treat a variety of psychiatric and neurological conditions, including schizophrenia and bipolar disorder.

Understanding Dopamine Blockers

Dopamine is a neurotransmitter involved in controlling the body's movements. When its function is blocked for an extended period, it can lead to an over-sensitivity of the dopamine receptors. This can result in uncontrolled, repetitive movements, primarily in the face, mouth, and tongue. Movements associated with TD include lip-smacking, tongue protrusion, and grimacing.

Risk Factors for TD

Certain factors increase a senior's risk of developing TD. These include being over the age of 55, being female, having a history of mood disorders, and using higher doses of neuroleptic medication for prolonged periods.

Other Neurological Conditions

While TD is a prominent cause, other neurological disorders can also lead to involuntary tongue and mouth movements.

Parkinson's Disease

Known for its tremors, Parkinson's disease can also cause orofacial movements, particularly levodopa-induced dyskinesia (LID), which occurs as a side effect of long-term treatment with levodopa medication. LID can present as writhing or jerking movements of the limbs, trunk, or face.

Dystonia and Chorea

Dystonia is a movement disorder characterized by involuntary muscle contractions that cause repetitive twisting movements and abnormal postures. If it affects the orofacial region, it can cause tongue protrusion. Chorea, a feature of Huntington's disease, causes brief, irregular, and jerky involuntary movements that can also affect the face and mouth.

Essential Tremor

Essential tremor is another movement disorder that commonly affects the hands but can also cause a tremor in the head, voice, or tongue. Unlike TD, these movements are typically present during action rather than at rest.

Oral Health and Sensory Feedback

Dental issues and related sensory changes can also contribute to orofacial movements in seniors.

Edentulous Dyskinesia

This is a condition characterized by repetitive movements of the jaw, mouth, and tongue in elderly individuals who have lost their teeth (edentulous). It is believed to be caused by reduced sensory feedback from the mouth and jaw following tooth loss. These movements can sometimes be confused with TD but are generally confined to the oral region.

Poorly Fitting Dentures

Dentures that do not fit correctly can cause discomfort and irritation, leading a person to constantly adjust their jaw or tongue to find a comfortable position. This can manifest as repetitive tongue or chewing movements.

Medication-Related Issues Beyond TD

Beyond the primary culprits for tardive dyskinesia, a wider range of medications can cause similar side effects, particularly in sensitive elderly patients. Many of these drugs affect neurotransmitter pathways, similar to antipsychotics but in different ways or with varying potency.

• Antidepressants: Certain older antidepressants (tricyclics) and even some newer SSRIs have been linked to causing dyskinesia in some cases.
• Anti-seizure medications: Several anti-seizure drugs can also trigger movement disorders as a side effect, which may include orofacial movements.
• Anti-nausea medications: Some antiemetics like metoclopramide can block dopamine and cause TD, even with relatively short-term use.

How to Manage and Diagnose

Observing involuntary tongue movements in an elderly loved one requires medical attention. Early diagnosis is key to managing the condition and potentially preventing it from worsening.

The Diagnostic Process

A healthcare provider, likely a neurologist, will conduct a thorough assessment. This includes a detailed review of the patient's medical history, current and past medications, and any other neurological symptoms. They will perform a physical examination, often observing the patient's movements and looking for specific patterns associated with different movement disorders. A crucial step is distinguishing between tardive dyskinesia, which is medication-induced, and spontaneous orofacial dyskinesia that can occur in the edentulous elderly.

Treatment Options

Treatment is highly dependent on the underlying cause. If a medication is the culprit, the doctor may recommend one of the following:

• Medication Adjustment: Safely discontinuing or switching the offending medication under medical supervision. This must be done carefully, as abrupt stopping can sometimes worsen symptoms temporarily.
• Specific TD Medications: The FDA has approved specific medications like valbenazine and deutetrabenazine to treat tardive dyskinesia.
• Botulinum Toxin Injections: For focal dystonias affecting the tongue or face, targeted Botox injections can help relax the overactive muscles.
• Oral Health Interventions: If dental issues or dentures are a factor, resolving these problems with a dentist can alleviate the movements.

Comparison Table: Common Causes of Involuntary Tongue Movements

Feature	Tardive Dyskinesia (TD)	Edentulous Dyskinesia	Parkinson's Disease (LID)
Cause	Long-term use of dopamine-blocking meds.	Lack of sensory feedback from tooth loss.	Long-term levodopa therapy.
Symptoms	Repetitive, involuntary tongue, lip, and jaw movements.	Repetitive, aimless movements of jaw, mouth, and tongue.	Jerking or writhing movements.
Affects	Face, mouth, tongue, and sometimes limbs/trunk.	Primarily jaw, mouth, and tongue.	Variable, can affect limbs, trunk, and face.
Onset	Months to years after starting medication.	Can occur anytime after tooth loss.	After long-term use of levodopa.
Treatment	Med adjustment, valbenazine, deutetrabenazine.	Dental treatment, well-fitting dentures.	Med adjustment, other anti-parkinsonian meds.

Conclusion

While involuntary tongue movements in an elderly person can be concerning, they are a symptom with identifiable causes, many of which can be managed with proper medical intervention. The key to effective treatment lies in accurate diagnosis, which often involves a comprehensive review of the patient's medication history and a careful neurological examination. It is vital to consult a healthcare professional for any signs of unexplained movements, as a correct diagnosis can significantly improve a senior's quality of life and overall well-being. For more information on neurological symptoms, visit the Mayo Clinic's Movement Disorders page.

Frequently Asked Questions

What is the most common cause of involuntary tongue movement in the elderly?

The most common cause is tardive dyskinesia, a movement disorder caused by the long-term use of certain neuroleptic medications, particularly older antipsychotics used for psychiatric disorders.

Can dental problems cause involuntary tongue movements?

Yes, tooth loss (edentulism) can lead to a specific type of movement disorder called edentulous dyskinesia, believed to be caused by a lack of sensory feedback in the mouth. Ill-fitting dentures can also be a factor.

Is this a sign of dementia or Alzheimer's disease?

While involuntary movements can be a symptom of some neurological conditions, they are not a specific sign of dementia or Alzheimer's. However, a doctor will consider all possible neurological causes during an evaluation.

Can medication changes make the tongue movements worse?

In some cases, yes. When discontinuing or reducing the dosage of a medication that has caused tardive dyskinesia, symptoms can sometimes temporarily worsen before improving. This is why any medication change should be managed by a doctor.

What should I do if my elderly parent starts moving their tongue involuntarily?

It is important to schedule a medical evaluation with a healthcare provider immediately. They will assess the symptoms, review all medications, and determine the correct diagnosis and treatment plan.

Are there medications to treat this condition?

Yes, for tardive dyskinesia specifically, the FDA has approved medications like valbenazine and deutetrabenazine. For other causes, treatment will depend on the diagnosis.

Is an involuntary tongue movement always a sign of a serious illness?

Not necessarily, but it always warrants a medical check-up. While it can be a side effect of medication or dental issues, it is important to rule out more serious neurodegenerative diseases.

Can stress or anxiety cause orofacial movements in seniors?

While stress and anxiety can sometimes exacerbate existing neurological symptoms, they are not typically the primary cause of sustained involuntary tongue movements. A doctor can help distinguish between psychological and physiological causes.