What Are the 5 Stages of Parkinson's Disease? Here's What Happens at Every Stage
Symptoms tend to come on slowly for most people, especially in early stage Parkinson's disease. Here's what to expect as the disease progresses.
The stages of Parkinson's disease can help give a person and their doctor an idea of how the disorder may progress. The disease is characterized by certain hallmark symptoms (resting tremor, stiffness, and slowness of movement), but no two cases of the disease are alike.
A person may experience only mild symptoms that don't interrupt their daily activities in the early stages of Parkinson's disease. Over time, people with Parkinson's disease may develop severe mobility challenges that make it difficult to stand or walk.
While there's no telling what any individual's Parkinson's disease stages timeline will look like, understanding what to expect over the course of the disease can help you and a caregiver plan ahead.
What are the 5 stages of Parkinson's disease?
Parkinson's disease is a neurological movement disorder that's progressive, meaning symptoms worsen over time. According to the Parkinson's Foundation, most people move through the stages of Parkinson's disease gradually (and if symptoms happen to get worse quickly, over days or weeks, it might be a sign that something else is going on).
There's no lab test that can tell a person which stage their disease is in. Instead, it's based on how severe a person's movement symptoms are, and how much the disease impacts their ability to go about daily life.
While the stages of Parkinson's disease can look a little different for everyone, here's a typical pattern of the disease, per the Parkinson's Foundation:
In the early stages of Parkinson's disease, a person may have mild motor symptoms, like a tremor, but can still go about their daily life, whether they're working, running errands, or enjoying hobbies, without incident. Movement symptoms usually occur only on one side of the body is involved. Stage 1 Parkinson's disease may include changes in a person's facial expressions, posture, or walking, as well.
Symptoms become more noticeable in stage 2 Parkinson's disease. Movement difficulties and muscle stiffness tend to affect both sides of the body and chores may become more time-consuming. The person at this stage of Parkinson's might also have trouble walking or maintaining good posture.
Stage 3 is considered mid-stage Parkinson's disease. It's when a person often begins to have a loss of balance and a higher risk of falling. (Here are some tips on preventing falls at home as you age in place.)
Everyday activities like cooking, cleaning, dressing, and eating can be more challenging, but most people with stage 3 Parkinson's disease are still fully independent.
In stage 4 Parkinson's disease, a person starts to experience more severe and debilitating symptoms. They may need to use a walker or another form of assistance to get around. You may need full-time help to live in your home as you progress through mid-to-late stage Parkinson's.
This is the most advanced stage of the disease and symptoms can be intense. A person with late stage Parkinson's disease usually has leg stiffness that prevents them from standing or walking. They may need to use a wheelchair or be unable to leave their bed, and require 24/7 nursing care while living with stage 5 Parkinson's disease. Hallucinations and delusions also become more likely at this stage.
Doctors may refer to these stages of Parkinson's as the Hoehn and Yahr scale: stages 1 and 2 are considered early-stage; stages 2 and 3 are considered mid-stage; and stages 4 and 5 are considered late-stage.
What are the non-motor symptoms of Parkinson's?
Parkinson's disease stages are defined by the severity of a patient's motor symptoms and how much those symptoms impact one's ability to function every day. But there are non-motor symptoms that are more likely to develop later in the disease, too, and a doctor may take those into consideration when assessing someone with the disorder.
For example, people with late-stage Parkinson's disease might have difficulty chewing, eating, speaking, or swallowing ("dysphagia"), which is considered both a motor and non-motor symptom. Dysphagia in particular can lead to serious health problems like malnutrition, dehydration, and aspiration.
In the final stages of Parkinson's disease, a person might develop cognitive changes, including slowness of memory or thinking, trouble planning and accomplishing tasks, and difficulty concentrating. (According to the Parkinson's Foundation, approximately 50% of people with Parkinson's will experience some form of cognitive impairment, and that can lead to full-blown dementia for some.) Or they might notice changes in their bone health or vision.
But there's no telling for sure if or when these symptoms will occur in any individual because Parkinson's disease symptoms vary from person to person.
How fast does Parkinson's disease progress?
People tend to move through the Parkinson's disease stages slowly, usually over the course of years. Research has shown that the disease tends to progress less rapidly in people who are diagnosed at a younger age (say, their mid-50s) than those diagnosed later in life.
What's more, Parkinson's disease may begin decades before a patient even notices a single motor symptom.
"We know that Parkinson's disease actually starts many, many years before you see that tremor or that shuffling," Lynda Nwabuobi, MD, assistant professor of clinical neurology at Weill Cornell Parkinson's Disease and Movement Disorders Institute, tells Health. "We think at least 30 years."
That early stage of Parkinson's disease is called the "pre-motor" stage. It happens before a person has been diagnosed, and may include symptoms like loss of smell, REM sleep behavior disorder (where a person acts out their dreams), and constipation.
"Patients will often tell you, 'Yeah, I haven't had a good sense of smell for many, many years,'" Dr. Nwabuobi says. "Or their spouse says, 'He kicks a lot in his sleep. He's done that since we were married.'"
But the reality is that, as with Parkinson's disease symptoms, Parkinson's disease progression will vary from person to person. "Some people have had Parkinson's for two years and they're not doing so well," Dr. Nwabuobi says. "And then some people have Parkinson's for 20 years and they're doing great and living their lives."
Fortunately, treatments can help a person manage symptoms and live a more functional life throughout many stages of Parkinson's disease.
"We have a lot of very good medications," Dr. Nwabuobi says. "I tell people, 'If you're to get a neurodegenerative disease, Parkinson's is not a bad one to have.'"
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