While everyone with Parkinson's experiences the disease differently, it is broken down into several stages depending on the symptoms. In this article, we look at the signs and symptoms that are typically present at each stage of the disease.
What are the stages of Parkinson's?
Parkinson's disease is broken into five stages. Each stage presents changing or new symptoms that a person is likely to encounter.
Dividing the disease into stages helps doctors and caregivers understand and address some of the challenges a person is experiencing as the disease progresses.
The five stages of Parkinson's measure the severity of symptoms.
During the initial stages of Parkinson's disease, the symptoms are typically not severe. A person can perform everyday tasks with minimal issues, so many of the signs and symptoms of stage 1 can be missed.
Some signs and symptoms of this stage include changes in:
- facial expressions
In addition, a person may experience mild tremors on one side of the body. A doctor might prescribe medication at this stage that will help control the symptoms.
Tremors, trembling, and stiffness affect both sides of the body in stage 2 of the disease and are much more noticeable.
The increased stiffness is often enough to delay tasks. A person may find it difficult to maintain independent living, according to their age and other factors.
Walking, speech, and posture problems are often more noticeable in stage 2 of Parkinson's.
Stage 3 or mid-stage Parkinson's disease is characterized by an increase in symptoms. A person will experience most or all of the symptoms of stage 2, plus:
- problems with balance
- slow movements
- slow reflexes
A person with stage 3 Parkinson's must be aware of the increased likelihood of falling due to coordination issues. Dressing and other self-care tasks may become more difficult.
Treatment at this stage often involves both medication and occupational or physical therapy. Some people respond favorably to treatment, while others may not experience much improvement.
During stage 4 Parkinson's, daily activities may be challenging or even impossible. It is likely that a person will require some form of daily care, as independent living is not usually possible.
People at this stage may be able to stand on their own but may need a walker or other assistive device to walk.
Stage 5 is the last and most debilitating stage of Parkinson's disease. A person will not be able to stand or move around due to stiffness. Depending on their age and health, they may be bedridden or use a wheelchair for mobility.
Unlike earlier stages, a person will need constant nursing aides. Aides will help the person do daily activities and prevent dangerous situations or accidents from occuring.
In stage 5, a person may also experience:
- poor response to medication
Signs and symptoms
Parkinson's disease may affect a person's ability to stand up or balance.
The main symptoms of Parkinson's disease include:
- slow movement or bradykinesia
- uncontrollable shaking and tremors
- stiff limbs
- issues with balance
- problems standing up
It is very common for people to focus on the physical or motor symptoms of Parkinson's. However, there are several non-motor symptoms associated with the disease, as well.
Non-motor symptoms include:
- problems with smell
- vision problems
- cognitive changes, such as memory loss or slow thinking
- problems with speech
- difficulty swallowing
It is usual for the symptoms of Parkinson's to be only slightly bothersome or uncomfortable initially but to get more severe as the disease advances.
A doctor will often reference a scale when discussing Parkinson's with an individual. The scale is used to help determine the progression of the disease.
The stages, as mentioned above, follow how the person regresses, or how their symptoms worsen. Most scales are based on motor symptoms, but other scales focus on non-motor symptoms.
There are two common scales doctors use:
- Unified Parkinson's Disease Rating Scale (UPDRS)
- Hoehn and Yahr stages
Unified Parkinson's Disease Rating Scale (UPDRS)
The UPDRS is a comprehensive tool used to look at a variety of symptoms. Some of the symptoms it assesses include:
- mental functioning
- social interaction
Looking at a wide variety of symptoms helps doctors get a better idea of how Parkinson's is affecting a person's everyday life, not just their motor skills.
Hoehn and Yahr stages
Hoehn and Yahr stages is a relatively simplistic scale. It focuses on the progression of motor symptoms.
Motor symptoms are rated on a scale of 1 to 5 points. The scale is very similar to the five stages of Parkinson's:
- 1–2 points is the early stages
- 2–3 points is the mid-stages
- 4–5 points is considered advanced stages
How does Parkinson's progress?
Research into the progression of Parkinson's is still ongoing.
Currently, doctors and researchers use a theory known as Braak's hypothesis. The hypothesis or theory is that Parkinson's starts in a few parts of the central nervous system, including:
- the enteric nervous system
- the medulla
- the olfactory bulb
The olfactory bulb affects the sense of smell, so researchers are looking into how to use smell as an early detection sign of the disease.
The Braak's hypothesis further explains that Parkinson's only extends to the brain's substantia nigra and cortex, affecting movements, when the disease has progressed. These areas are responsible for the other motor and non-motor symptoms of the disease in later stages.
Currently, there is no known cure for Parkinson's disease. Once Parkinson's is diagnosed, the symptoms can often be treated with medications and therapies, especially in the early stages.
As the disease progresses, people may experience a reduced quality of life if their normal functions, such as swallowing and eating, start to be affected.
While Parkinson's is not life-threatening, people may experience life-threatening complications, such as choking on food or falling down.