Parkinson’s Disease stages: A Complete Guide

 

Many of us have watched our grandparents’ hands shake when they pick up a cup or watched their posture begin to slump more and more. In some cases, those changes and occurrences are due to Parkinson’s disease. What is Parkinson’s disease? What are the different stages of Parkinson’s? What are some tips to deal with Parkinson’s disease stages?

Parkinson's disease stages
Parkinson’s disease stages- in the late Parkinson’s disease stages, it becomes necessary to use a walker if not a wheelchair.

What are the Parkinson’s disease stages?

Parkinson’s disease, also known as PD, is the second most common long-term neurodegenerative disorder in the central nervous system. It mostly affects the motor system and the symptoms become stronger with time. It’s the number one, most common movement disorder. Most people develop the condition when they are over 60. However, there is Adult-onset Parkinson’s disease, which is common, early-onset (between 21-40 years) and juvenile-onset (before age 21).

The first description of Parkinson’s dates back to 5,000 B.C in an Indian civilization. While they called the condition Kampavata, they treated it with seeds form a plant that contained therapeutic levels of what we know today as levodopa (the most common drug used to treat Parkinson’s). The disease didn’t get the name we know today until British doctor, James Parkinson, described the disease as “shaking palsy” in 1817.

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People feel the progression of Parkinson’s at different speeds with different symptoms. That said, there are however patterns that occur that are defined as “stages”. There are five stages which are based on the Hoehn and Yahr Scale. Each person feels the stages differently and may spend more time in one stage than others. It’s a completely individual process. Not everyone will get the symptoms from that stage, either. For example, someone can have the tremor, but also have their balance intact. There is another scale used the Unified Parkinson’s Disease Rating Scale (UPDRA) which is more comprehensive and used to account for non-motor symptoms such as social interaction, mental functioning, and mood.

While there are treatments available for every stage, the earlier the diagnosis of Parkinson’s, the better and more effective the treatment can be at alleviating symptoms.

Parkinson’s disease stages- Non-motor symptoms

Parkinson’s Disease, although a neurodegenerative disease that affects the motor system, it affects more than just that. There are many other non-motor things that are affected and may require additional medication to treat. For instance:

  • Sleep. Fatigue and sleeping disorders such as insomnia are common.
  • Mood. Mood disorders such as depression and anxiety.
  • Throat issues which lead to problems with speech and swallowing.
  • Sensory changes, such as with the sense of smell and vision.
  • Constipation.
  • Cognitive changes that involve difficulties with planning, the slowing of thought, or memory.

Parkinson’s disease stages – Stage I

In Stage I of Parkinson’s, there are only mild symptoms that are seen only on one side on the body, unilaterally, with little to no functional impairment. Sometimes the early signs of Parkinsn’s are so mild that the person doesn’t realize they should see a doctor. It’s not an easy stage to diagnose and sometimes the doctor may wait to see if the symptoms worsen over time before making their final diagnosis. Some of the early symptoms include:

  • One limb being more clumsy than the other
  • Tremors. The trembling can occur in all the limbs, and often happen while in a resting position. They can worsen when the person is stressed, tired, or excited.
  • Changes in walking known as Parkinson’s Gait.
  • Rigidity
  • Changes in posture
  • One side of the face can be impacted in ways such as expression

Some prescribed medication can help with the tremors for a while.

One study tried to look at the predictors of cognitive decline in early-stage Parkinson’s. They took 61, early stage, non-dementia patients and assessed them twice over a two-year period using a global function test and motor function scales. The study concluded by finding that there are some traits that are helpful in predicting dementia and Parkinson’s. They also found that “non-tremor motor deficits could be predictive factors for frontal cognitive decline and dementia”.

Parkinson’s disease stages – Stage II

Stage II of Parkinson’s is still considered to be an early stage of the condition. However, it’s more serious than Stage I because the body, rather than having a unilateral impairment, has a bilateral impairment which means that there are symptoms on both sides of the body. Stage II can develop just months after stage I to years after. At this stage, a person can still do day-to-day activities, but they may be affected slightly.

It can be difficult to diagnose. For instance, if the patient has a tremor, and they weren’t diagnosed in Stage I and their only Stage II symptoms are slowness or stooped posture, the diagnosis could be misinterpreted for old, advancing age. Considering the difficult diagnosis, one study put together a load of different treatments for early Parkinson’s disease stages to help optimize the treatment. Recently, a lot of research has gone into non-pharmacological treatments for non-motor and motor symptoms of Parkinson’s. There is growing evidence that exercise is a viable therapy for mild to moderate stages of Parkinson’s.

Symptoms of Stage II Parkinson’s include:

  • Loss of facial expression on both sides of the face
  • Changes in voice such as speaking softly and in a monotone way
  • Decreased blinking
  • Speech difficulties
  • Overall slowness in daily activities, a condition known as Bradykinesia.
  • Stiff muscles. This stiffness can affect all the muscles in the body including the facial muscles which can make the face look “mask-like” and expressionless.
  • Stooping posture
  • Slurring speech

Parkinson’s disease stages – Stage III

Stage III Parkinson’s is considered to be a mid-stage, moderate, and is characterized by slowness while moving and a loss of balance. A diagnosis is easy to make in this stage because most symptoms present themselves during this stage. It’s important to know that someone with Stage III can still be completely independent in their daily lives such as hygiene, eating, and getting dressed. That said, these activities are significantly impaired due to the condition.

Symptoms of stage III Parkinson’s include:

  • Falling often with a loss of balance
  • A tremor
  • Changes in walking
  • Rigidity
  • Changes in posture
  • Loss of facial expression on both sides of the face
  • Changes in voice such as speaking softly and in a monotone way
  • Decreased blinking
  • Overall slowness in daily activities
  • Stiff muscles
  • Stooping posture
  • Slurring speech
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Parkinson’s disease stages – Stage IV

Stage IV Parkinson’s is a stage that is crippling, sometimes literally, to the person. It’s disabling because they should be able to stand without too much assistance, but they are in lots of pain and it costs their bodies a lot to do so. Many people at this stage begin to use a walker and they often need assistance in their daily lives. Many can’t live on their own once they reach this stage.

Some studies suggest using palliative care, the process of treating the symptoms and not the condition, for late-stage Parkinson’s. Another study claimed that the effects of pharmacological treatments used for Parkinson’s disease are present for many years. For example, the occurrence of dyskinesia, the impairment of voluntary movement, and the drug effect “wearing off” with the progression of the condition. Many non-dopaminergic agents are now being used to investigate the relief of non-motor symptoms and the treatment of dyskinesia. The study concluded saying that the treatment of late-stage Parkinson’s Disease remains problematic because many non-motor symptoms, as well as motor symptoms, are left without (good) treatments.

Parkinson’s disease stages – Stage V

Stage V is the most advanced of the Parkinson’s Disease stages. It is known for being able to keep the patient from getting up from a chair, out of bed, or walking without help. A person will also have issues with falling when turning or simply standing, as well as stumbling lots while walking. Someone with Stage V Parkinson’s needs round-the-clock assistance to reduce any risk of falling. Some Stage V Parkinson’s people also experience hallucinations and/or delusions in this stage. Some people will have such stiffness in the legs that they can’t walk or stand. Others require a wheelchair and a few are bedridden.

Some researchers found the importance that both pharmacological treatments and supportive treatments (such as counseling, having help around the house, etc.) can help someone suffering from Parkinson’s- especially at a late stage.

Parkinson’s Disease Stages- Prognosis & Treatment

You can die with Parkinson’s, but not from it. Parkinson’s itself isn’t fatal. That said, the worse the symptoms get, the more likely one can die. For example, falling can result in death depending on the age and fall. In advanced stages, swallowing can be difficult and some people aspirate food into their lungs which can cause pneumonia, other pulmonary conditions, or perhaps they can simply choke. It’s important to stay in shape as much as possible when dealing with Parkinson’s because the prognosis depends largely on one’s age, overall health, and the Parkinson’s disease stages. Studies have shown that compared to people without the condition, people suffering from Parkinson’s disease have the same general life expectancy. An Austrailian long-term study found that the mortality rate that comes with the Parkinson’s disease stages remains high and increased even though the participants were having low-dose levodopa-carbidopa therapy. They found that the mortality rates were similar to those without the levodopa treatment.

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However, there are some things that simply can’t be stopped easily. For example, up to 30% of Parkinson’s patients at Stage IV or Stage V go through delusional spells with confusion and hallucinations. This is in addition to dementia which occurs in up to 75% of Parkinson’s patients.

Considering that as of 2017 there is no cure for the condition and there is no known cause, it’s hard to find a treatment that works well for everyone. However, it’s probably due to one’s environment and susceptibility factors and not genetic. Only 10% of Parkinson’s patients have relatives who are also going through or have had Parkinson’s. Twice as many men have the condition compared to women.

Tips to deal with the Parkinson’s disease stages

  • Find out how you can help a loved one going through the different Parkinson’s disease stages here.
  • Patience is key.
  • Stay mentally strong by playing puzzles and using cognitive games.
  • Learn everything you can about the condition and try to understand the non-motor and motor symptoms to better understand what one is going through or what will happen. Some excellent resources to learn for you and for families are the American Parkinson’s Disease Association, The Michael J. Fox Foundation, and The National Parkinson’s Foundation.
  • Use support groups.
  • Keep track of appointments and doctors visits. It’s important not to miss them.
  • Understand that everyone is different and will progress through different stages at different paces.
  • Try exercising. When we exercise, our bodies release dopamine, a neurotransmitter necessary for our happiness and our movement.
  • Support the independence of a loved one if they are trying to walk on their own or cut their own food. Help them feel as normal as possible
  • Help maintain one’s quality of life- for both the patient and the caregiver.
  • Set realistic goals for yourself.

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Anna is a freelance writer who is passionate about translation, psychology, and how the world works.