Understanding the 5 Stages of Parkinson’s Disease

As Parkinson’s Awareness Month continues, we’re publishing this series of articles to provide essential information that people should know about the disease. In our last article, we discussed how Parkinson’s disease (PD) is the second-leading neurodegenerative disorder in the United States, early indicators, and how dopamine deficiency causes its physical symptoms.

In today’s article, we’re talking about the 5 stages of Parkinson’s disease. While no two journeys with PD are exactly alike, understanding the disease’s progression can help patients and families prepare for the road ahead. Keep reading to learn more.

Key Takeaways

Patients in stages 1–3 of Parkinson’s disease are still able to live on their own, but daily tasks are more difficult and take longer.
Independence is the main factor that separates stages three and four.
There are different rating scales to measure the progression of Parkinson’s disease in addition to the Hoehn and Yahr Scale

Researchers Margaret Hoehn and Melvin Yahr developed a framework to measure the progression of Parkinson’s disease (PD) in the 1960s, and doctors still use it today. However, it is not the only rating scale that is used to diagnose how severe a patient’s disorder is. (In fact, there are at least eight other scales/tests/questionnaires that can be used to determine where a patient is in their journey with PD.)

Here’s a breakdown of what those stages typically look like and how RMC’s neurology team is here to help at every step.

Stage 1: Mild, Often-Missed Symptoms

This early stage is subtle. Tremors or shaking might affect just one side of the body. Close family members may notice slight changes in posture, facial expressions, or walking patterns, but a person’s daily activities aren’t impacted yet. At this stage, symptoms are easy to overlook or misattribute simply to aging or fatigue.

Stage 2: Noticeable Changes Begin

At stage two, symptoms become more obvious and begin to affect both sides of the body. Muscle stiffness, slower movements, known as bradykinesia, and increased tremors can start to interfere with tasks. They may also begin to experience speech difficulties. Though a patient’s balance remains intact, everyday activities will start to take longer, and they will need to start seeking medical support.

There’s no way to predict individual progression as every PD case is unique. For some people, it only takes months to progress from stage one to stage two. For others, it can take years. During this time, patients remain independent

Stage 3: Mid-Stage Parkinson’s and Balance Issues

Stage three is considered mid-stage PD, at which point falling becomes a concern as balance issues begin to manifest. Reflexes also start slowing down, as well as overall movement. Patients can remain independent at this stage, but daily tasks will take them much longer. Some home adjustments may be necessary, or the patient may need to use assistive devices. Stage 3 can sometimes be aided by medication and physical or occupational therapy.

Stage 4: Significant Assistance Required

At stage four, a patient’s mobility becomes seriously compromised, and many need to employ the use of a walker to move around. They also need help with daily living activities like getting dressed, eating, and bathing. Living alone can be unsafe due to the increased risk of falling. Physical decline usually progresses faster than mental decline. So while a person may no longer be able to live alone, their cognition may still be relatively unaffected.

Stage 5: Advanced Parkinson’s

Stage five is the most severe stage of Parkinson’s disease. Patients are often unable to stand or walk due to the advanced stiffness in their legs, leaving them bedridden or confined to a wheelchair. Around-the-clock care is almost always necessary. Additionally, hallucinations, delusions, and dementia may develop.