The Five Stages of Parkinson’s Disease

It is widely accepted that Parkinson’s Disease progresses in five stages. This is known as the Hoehn and Yahr rating scale used to classify symptom severity and disease progression. These stages are:

1. Stage I: This is the initial stage of the onset of Parkinson’s Disease. At this time, symptoms are usually mild and don’t interfere with daily activities. Tremors and other movement symptoms are typically only experienced on one side of the body. There can also be changes in posture, walking, and facial expressions. Prescription medications can be effective in minimizing and reducing symptoms of Parkinson’s at this stage.
2. Stage II: Progressing from stage I to stage II can take months or years. Symptoms such as tremors, rigidity, and other movement symptoms get worse during Stage II and can spread to both sides of the body. Walking and posture problems can become apparent, but not enough to jeopardize independent living. Patients may still live alone but daily tasks can become more difficult and take longer to perform.
3. Stage III:Considered mid-stage and a major turning point for Parkinson’s Disease progression, stage III can bring about a loss of balance and a slowing of movements. Independent living is still possible but activities such as dressing or eating can become increasingly more difficult due to symptoms. Falls can become more prevalent. Medication along with occupational therapy can help decrease symptoms.
4. Stage IV: At this point in the progression, symptoms become increasingly severe and can drastically limit mobility . Independence is affected the most during stage IV and even though standing may still be independent, mobility may require medical aids such as a walker. Assistance with everyday chores and tasks is now required, and independent living may become dangerous if not impossible.
5. Stage V: At this stage of development, Parkinson’s Disease symptoms are at their most advanced and can become debilitating. It may become impossible to stand and walk due to stiffness in the legs and patients can become dependent upon wheelchairs or even become bedridden. The need for full-time nursing care is now required for all activities and patients may experience hallucinations or delusions.

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Alternative Ratings of Parkinson’s Disease

As there are also other non-movement symptoms like intellectual impairment associated with Parkinson’s Disease, alternative systems other than the movements-based Hoehn and Yahr rating scale may also be considered. Your doctor may use the MDS-Unified Parkinson’s Disease Rating Scale which uses 50 comprehensive questions on motor as well as non-motor symptoms. While this scale is more complex, it is considered more thorough and comprehensive. Some non-motor symptoms considered by this rating scale include:

• Difficulties with memory/planning and a slowing of thought
• Anxiety/Depression
• Speech or swallowing problems
• Insomnia

Parkinson’s Disease can progress differently in each individual and unfortunately does not have a cure. To make things worse, it does not appear to have a singular cause, and nor is it hereditary. Understanding the symptoms can help start an early intervention plan to maximize both the patient’s quality of life and the timespan of independent living.

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