A Closer Look At The Progression of Parkinson’s Disease
Parkinson’s Disease (PD) is a progressive condition affecting movement (Mayo Clinic, 2018). It is a disorder related to the nervous system. Symptoms are such that they start gradually and may even be unnoticeable at first. Tremors are one of the most common symptoms when it comes to PD (Mayo Clinic, 2018). However, tremors are not the only symptom caused by this disorder. PD also causes slowing down of movement, stiffness within the body, as well as non-motor symptoms (Mayo Clinic, 2018). This overview helps explain Parkinson's Disease progression and the changes experienced through each stage.
Signs and symptoms of PD may include tremors, slowed movement, rigid muscles, impaired posture and balance, loss of automatic movements, speech changes, and writing changes on the motor symptoms side (Mayo Clinic, 2018). On the non-motor symptoms side, PD can cause loss of smell, pain, and dementia (Ratini, 2017). These signs and symptoms can all vary in intensity depending on the progression of the condition.
The progression of PD is quite individualized and affects people differently. It is not necessary that all individuals with PD experience all the same symptoms at the same severity (Downward, 2017). This can vary exceptionally, as different individuals will experience neurodegeneration at different speeds. Parkinson's Disease progression is categorized into five stages. These stages of Parkinson's Disease are known as the Hoehn and Yahr Scale, which is used as an international standard scale for rating and keeping track of PD advancement (Healthline, 2018).
Understanding the 5 Stages of Parkinson’s Disease
Before reviewing each phase individually, it helps to understand how the 5 stages of Parkinson’s Disease outline the typical pattern of symptom development. These recognized stages of Parkinson’s Disease move from mild, often subtle changes in movement to more noticeable challenges with balance, mobility, and daily independence. While the Hoehn and Yahr scale provides a useful framework for describing Parkinson’s Disease progression, it is important to remember that every person’s experience is unique. Some progress slowly, others remain stable for long periods, and not all individuals reach the later stages. This overview helps patients and caregivers prepare for potential changes while emphasizing that progression can vary significantly from one person to another.
The 5 Stages of Parkinson's Disease Progression
Stage 1
The earliest stage of PD, where mild to no functional symptoms may be present on one side of the body known as unilateral involvement (Downward, 2017). Symptoms during this stage are often mild and may not noticeably impact daily activities, and may be difficult to identify without a clinical evaluation. (Downward, 2017). Possible symptoms of stage one PD include slight changes in walking, posture, or facial expressions that may be noticed by close family and friends but otherwise missed (Henderson, 2019).
Stage 2
The early disease stage of PD, where symptoms start appearing on both sides of the body known as bilateral involvement (Henderson, 2019). It is quite common that tremors and rigidity may become slightly worse, and some postural and daily tasks and walking difficulties may become quite noticeable (Henderson, 2019). However, at this stage, the individual can remain independent. Stage two can develop within months to years after stage one (Downward, 2017). Progressive symptoms include loss of facial expression, speech abnormalities such as slurring, softer voice, monotoned voice, or increase and decrease in voice as you speak, decrease in blinking, and stiffness (Downward, 2017). If tremor symptoms are noticeable, diagnosis can be easy at stage two. However, if noticeable symptoms are such that they can be misinterpreted, like slowness of movement, then it may be hard to diagnose, as it may just seem like advancing age (Downward, 2017).
Stage 3
The mid-stage of PD, where the decrease of motor characteristics is particularly noticeable (Henderson, 2019). Inability to make automatic, rapid, and involuntary adjustments will result in falls at this stage (Downward, 2017). Daily activities may require more time or additional support; the individual will start to experience difficulties with everyday tasks and activities; however, they can still perform them (Downward, 2017). Symptoms for stage 3 PD show impairment, and therefore, the diagnosis is much easier.
Stage 4
The later stage of PD, where the symptom progression is severely limiting (Henderson, 2019). Although the individual can stand without assistance, movement is greatly impaired (Henderson, 2019). During Stage 4, many individuals may need assistance with daily tasks due to increased mobility challenges. Many individuals may now start using walkers or canes even for moving around (Henderson, 2019).
Stage 5
In this advanced stage, many individuals require extensive assistance with daily activities. (Henderson, 2019). Assistance is needed for rising from the bed or chair to standing or even turning. At this stage, in some individuals, Parkinson’s Disease may be associated with neuropsychiatric symptoms such as delusions or hallucinations. (Henderson, 2019). Although symptoms are progressive, it is important to keep in mind that not all individuals will ultimately reach stage 5. Many individuals may have slower progression with fewer symptoms, or they may not have all the same symptoms as another individual (Downward, 2017). In general, progression and symptoms vary from individual to individual; therefore, some individuals may take a lot longer in one stage versus another or never reach past a certain stage.
It is important to keep in mind that treatment options are available at different stages of Parkinson’s Disease and are intended to help manage symptoms as the condition progresses. Early diagnosis can help guide timely treatment decisions and symptom management planning. Understanding Parkinson's Disease progression helps both patients and caregivers prepare for changes that occur during the stages of Parkinson's Disease.
Helpful Resources for Parkinson’s Disease
A list of resources for you or your loved ones who are struggling with PD and are not sure where to find information.
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National Parkinson’s Foundation – helps individuals live better with Parkinson’s. Helping to improve care and conducting research for advancement.
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Michael J. Fox Foundation– helping to find a cure through research and raising money. Latest news, information database, and blogs on Parkinson’s disease.
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Parkinson’s Disease Foundation– information and knowledge via news, latest research, upcoming events, and educational information on the disease.
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com – support and caregiving resources and tools.
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The Davis Phinney Foundation supports programs, research, and extensive information on living well with Parkinson’s.
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The Parkinson Alliance– fundraising through their unity walk each year, providing current research information and news.
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American Parkinson’s Disease Association: providing support, education, and research for individuals and families affected by Parkinson’s Disease
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References
Downward, E. (2017). What are the Stages of Parkinson’s? Retrieved from https://parkinsonsdisease.net/basics/stages/
Healthline. (2018). 5 Stages of Parkinson’s. Retrieved from https://www.healthline.com/health/parkinsons/stages
Henderson, W. (2019). 5 Stages of Parkinson’s Disease. Retrieved from https://parkinsonsnewstoday.com/2017/08/23/five-stages-of-parkinsons-disease/
Mayo Clinic. (2018). Parkinson’s Disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055
Ratini, M. (2017). Stages of Parkinson’s Disease: How Symptoms Can Change Over Time. Retrieved from https://www.webmd.com/parkinsons-disease/guide/parkinsons-disease-progression#1
