Parkinson’s Disease Stages

When a loved one gets diagnosed with Parkinson’s, we want to know what to expect. How will this disease progress? How can we best be prepared?

Parkinson’s disease is a progressive neurological disease. At this time, there is no cure, and the disease typically progresses through a series of stages. As an individual with Parkinson’s disease, it is important to be informed of the stages of Parkinson’s disease and how the disorder progresses.

Parkinson’s Disease Stages Based on Patient Symptoms

PD progresses in a somewhat predictable manner. Onset can start as young as age 40 (young-onset); most patients are around 60 years old when diagnosed. The earliest non-motor symptoms are problems with olfaction (loss of smell) and digestive issues (especially constipation). Motor symptoms typically arise within the first stage of the Parkinson’s disease.

A Parkinson’s disease staging system was defined in 1967 by Dr. Hoehn and Yahr. They published a study in the Journal of Neurology with a sample size of 800 Parkinson’s patients. During this study, they saw a difference in symptoms between patients, but the similarity in the severity of symptoms.

They developed a Parkinson’s disease staging system based on the level of disability that the patient experiences. The staging system was designed to be practical and to assess a patient’s level of functionality.

  • Stage 1 – Unilateral involvement / limited functional impairment

This stage represents the emergence of unilateral symptoms (on one side of the body) such as tremors or other movement symptoms. Changes in posture, walking, or facial expressions may occur at this point.4

  • State 2 – Bilateral or midline involvement, without impairment of balance

Symptoms appear bilaterally (on both sides of the body). Tremor and rigidity affect both sides. Problems with walking and poor posture may be present during this stage.

  • Stage 3- First sign of impaired righting reflexes, mild to moderate disability

Balance issues and slowness are the hallmarks of this stage, making falls more common. The patient will still be able to walk during this time, but activities of daily living (ADL’s) are more difficult. The patient may require daily assistance with certain tasks.

  • Stage 4- Fully developed PD, severely disabling disease

During stage four, symptoms can become severe. Movement may require a walker, and assistance with ADL’s. The patient may require a caregiver or may be unable to live alone.4

  • Stage 5- Confinement to bed or wheelchair unless aided

At this time, the patient may require around the clock nursing care. Stiffness and rigidity of their body may make it impossible to stand or walk, making the patient wheelchair or bed-bound. Patients may experience hallucinations and delusions at this point.

A Peek into the Brain: How Parkinson’s Disease Progresses

Idiopathic Parkinson’s disease (PD) comprises about 90% of Parkinson’s cases. A defining pathologic feature of PD is the buildup of a protein called alpha-synuclein as well as the presence of Lewy bodies in the brain.

Alpha-synuclein is the main component of Lewy bodies. These are proteins that interfere with the brain’s ability to function, recycle and use proteins properly.

Parkinson’s Disease Stages 

According to Spread of Alpha-Synuclein and Lewy Bodies

In 2003, a Parkinson’s disease staging system was outlined to show the spread of these proteins throughout the brain. According to the Parkinson’s disease stages system, the buildup of these proteins begins in the olfactory bulb and/or the dorsal motor nucleus of the glossopharyngeal and vagal nerves (nerves that control your throat and stomach, among other things).

Stage 2

In stage two, Lewy pathology develops in other parts of the brain, the medulla oblongata and the pontine tegmentum.

Stage 3

In stage three, motor symptoms start to emerge as pathology reaches the amygdala and the substantia nigra (the SN is the site of dopamine cells where movement originates).

Stage 4

Pathology worsens in stage four as the alpha-synuclein inclusions reach the temporal cortex.

Stage 5 and 6

During stage five and six, Lewy bodies reach the neocortex, which accounts for cognitive decline noted in advanced cases of PD.

While the physiologic stages of the disease begin during a time when symptoms are not present, this staging illustrates the path of the disease through the central nervous system.

While faced with a progressive illness, support and planning are necessary. No matter what stage of Parkinson’s disease a person is in, there is hope for the future. There are doctors, treatments, and therapies to support Parkinson’s disease in each stage of progression.

This article is not intended to diagnose or treat any individual with Parkinson’s disease. This article was created for educational purposes only and is not a substitute for medical, psychological, or any other sort of professional care. Please always contact your medical provider with any questions or concerns involved with the treatment for hallucinations and Parkinson’s disease.

Please reach out to us at support@theparkinsonsplan or get in touch for more information on how we can help with Parkinson’s disease.

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