Parkinson’s disease is a progressive and highly variable brain disorder that affects movement. The rate at which the disease progress varies from one person to another. Some develop disease complications early; others face them late. Disease progression also depends on age. Usually, the disease advances more slowly in young people.
Parkinson’s disease progression can be classified into 5 main stages, which is based on the most commonly used method called the Hoehn and Yahr scale. The scale was originally developed by two researchers Melvin Yahr and Margaret Hoehn in 1967 and is used by most physicians around the world to find out the disease severity.
Stage 1 – the early mild stage of Parkinson’s disease
In this early stage of the disease, motor symptoms start to appear on one side of the body. These include slight shaking of the hand, pain in the body, and change in facial expression. The patient usually overlooks these symptoms and do not associate them with Parkinson’s disease. In fact, the symptoms are so mild that it is even difficult for the physician to diagnose the disease at this stage.
Stage 2 – the mild stage of Parkinson’s disease
In stage 2, the classical motor symptoms of the disease becoming noticeable and therefore the disease can easily be diagnosed at this stage. The symptoms appear on both sides of the body and begin to bother the patient’s life. However, these symptoms can easily be treated with medications. In some people, motor symptoms may not all be present.
Most common symptoms in stage 2:
- Tremor: Fingers are most commonly affected, jaw muscles may also be involved. The hand tremor appears at rest and disappears with voluntary movement.
- Movement problem: The gait becomes slow and the patient usually shows loss of arm swing on one side.
- Reduce facial expression: The patient usually gives a mask-like expression and has a fixed stare.
- Body stiffness: Body parts feel increased resistance to stretching, usually the limbs are more affected. Rising from deep chairs or rolling over in bed becomes difficult for the patient.
- Small handwriting (micrographia).
- Social phobia: The patient starts to lose interest in pleasurable activities.
Stage 3 – the moderate stage of Parkinson’s disease
This is the middle stage of the disease where motor symptoms become more pronounced and start to affect patient daily functions. The patient can still live independently but may feel difficulty in performing daily tasks like taking shower, getting dressed, and taking shoes on. In addition, walking can be problematic and sometimes result in falls that cause injuries. To reduce these complications, the patient may need assistive devices.
Additional symptoms that appear in this stage include:
- Postural abnormality
- Freezing while walking
- Feels of falling when changing position such as sit to stand or turning.
- Wriggling or Jerky movements: This generally appears due to the long-term use of levodopa drug.
- Reduced swallowing
- Trouble in small movements; for example using small tools, fastening button, and brushing the teeth.
- Excessive daytime sleepiness
Stage 4 – the advanced stage of Parkinson’s disease
This is considered the advanced stage of the disease during which the symptoms become severe and problematic. Loss of balance is common that can lead to falls and result in serious injuries. The patient can still stand and walk but may need a walker all the time. The patient increasingly depends on others for functioning. Depression-like symptoms may also appear in some patients.
Stage 5 – the most advanced stage of Parkinson’s disease
This is the late stage of Parkinson’s disease where the patient completely depends on others for functioning. The patient finds it difficult to move and need a wheelchair. This stage is also accompanied by behavioral symptoms such as delusions and hallucinations. Moreover, the patient becomes sensitive to infections such as pneumonia.
One main limitation of the Hoehn and Yahr scale is that it entirely relies on motor symptoms and doesn’t take into account the cognitive or other non-motor symptoms. Due to this, some physicians may prefer to use an alternative method known as the Unified Parkinson’s disease Rating Scale. This scale is more inclusive as it covers both the motor symptoms and the non-motor symptoms, including mental functions, mood, behavior.
Disclaimer: The information shared here should not be taken as medical advice. The opinions presented here are not intended to treat any health conditions. For your specific medical problem, consult with your health care provider.