Bulbar effects can also include tongue twitches or fasciculation. A reduced ability to swallow can show as excessive saliva or drooling, and in addition to dysphagia, there can be a choking sensation when lying flat. Dysarthria and dysphagia can sometimes suggest a misdiagnosis of a stroke or throat blockage.^3,11

While any cognitive changes will typically be mild, some people develop more severe cognitive changes, usually as MND with frontotemporal dementia or FTD.¹

Senses are not usually affected, although some may find taste or skin sensitivity changes. Bladder and bowel function is retained, but the limited mobility will make it harder to get to the toilet in time. Reduced mobility can also impact on sexual expression although sexual function remains.²