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 .
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:
What Are The Stages Of Parkinson’s Disease
Parkinson’s disease is a progressive neurological disorder. There are five generally recognized stages of Parkinson’s disease. The progression of the disease may vary from one patient to the next, and not all patients will experience all five stages of Parkinson’s disease in their generally accepted order. Symptoms may also vary throughout the progression of Parkinson’s disease.
While doctors have currently identified five distinct stages of Parkinson’s disease, not all patients will experience a straightforward disease progression that passes through all five stages, one after the other. Nor will all patients remain in all stages for the same length of time. The five stages of Parkinson’s often vary in duration from patient to patient. Disease progression is generally considered impossible to predict, with some patients experiencing all stages while other patients skipping from an early stage to an advanced stage without passing through the stages in between.
Is Parkinsons Disease Inherited
Scientists have discovered gene mutations that are associated with Parkinsons disease.
There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.
Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.
Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.
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Unilateral Involvement Only Usually With Minimal Or No Functional Impairment
The patient has tremor, rigidity, slowness and paucity of movement, or poor condition in the arm and/or legs on one side of the body. Occasionally one side of the face is involved, producing an asymmetry of expression that may look very like the effects of a mild stroke or Bells palsy. This stage of Parkinsons is often missed entirely. For example when the diagnosis is made at a more advanced Stage, the patient may remember having noticed an intermittent tremor of one hand many years before. Old home movies may show that the patient didnt swing one arm as much as the other did while walking. One hand or foot may have been clumsier than the other may have. Often these symptoms are so mild that no formal medical attention is sought. If sought it is not uncommon that the physician is unable to make a diagnosis, either by the most assiduous and astute physical examination or by the most advanced technology. Sometimes the disease must evolve over many years before a diagnosis can be made with certainty.
Usually was inserted into the original definition to modify minimal or no functional impairment: because, very rarely, a patient presents with very severe and disabling unilateral symptoms: extreme and violent tremor or rigidity and akinesia in one limb so severe that the limb is virtually paralyzed. Most doctors worry about a stroke or tumor which they should. When all necessary tests show nothing, one must wait and observe. Eventually Stage II may emerge.
What Are The 5 Parkinsons Disease Stages
Parkinson’s disease presents differently in everyone. However, Parkinson’s is a neurological disorder which tends to follow a pattern of recognizable symptoms. This is known among doctors as the Hoehn and Yahr rating scale, which is broken down into five Parkinsons disease stages. These marked stages will help your doctor evaluate your Parkinsons disease progression.
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How Is Parkinsons Disease Treated
There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.
What You Can Expect
Parkinson does follow a broad pattern. While it moves at different paces for different people, changes tend to come on slowly. Symptoms usually get worse over time, and new ones probably will pop up along the way.
Parkinsonâs doesnât always affect how long you live. But it can change your quality of life in a major way. After about 10 years, most people will have at least one major issue, like dementia or a physical disability.
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Understanding Lewy Body Dementia
Lewy body dementia consists of two different conditions: dementia with Lewy bodies and Parkinson’s disease dementia. The two share many of the same symptoms and may often be considered to be the same.
However, one significant factor in how Lewy body dementia progresses is related to which disease is actually present. In Parkinson’s disease dementia, the physical challenges are usually evident first, while in dementia with Lewy bodies, cognitive changes may appear earlier than, about the same time, or shortly after, the physical changes develop.
Whats Different About Young
The age of diagnosis matters for a variety of reasons, from probable causes of early cases to symptoms and treatment:
- Genetics. As with any case of Parkinsons disease, the exact cause is usually unknown. That said, The young-onset cases of Parkinsons disease are, on average, a bit more likely to be familial or genetic, says Gregory Pontone, M.D., director of the Johns Hopkins Movement Disorders Psychiatry Clinic.
- Symptoms. In many patients with YOPD, dystonia is an early symptom. People with YOPD also report more dyskinesia . They also tend to exhibit cognitive problems, such as dementia and memory issues, less frequently.
- Progression. Patients with young-onset Parkinsons appear to have a slower progression of the disease over time, says Pontone. They tend to have a milder course, staying functional and cognitively intact for much longer.
- Treatment. Most patients with Parkinsons take the medication levodopa. However, other drugs, such as MAO-B inhibitors, anticholinergics, amantadine, and dopamine receptor agonists, may be used before levodopa.
Challenges To Classify Disease Stages At The Boundary Of Advpd And Atypical Parkinsonism
During disease progression and based on the predominant motor and non-motor features associated with advPD, the separation from atypical parkinsonism may be difficult and overlap syndromes like minimal change multiple system atrophy or progressive supranuclear palsy with predominant parkinsonism have been described . AP includes a heterogeneous bunch of syndromes, all characterized by clinically manifest parkinsonism in combination with other clinical features and a poor therapeutic response to dopaminergic medication. Only post-mortem analyses can clearly differentiate from advPD, as their neuropathology is characteristically different: in MSA, alpha-synuclein accumulation is found and defines an alpha-syncleinopathy as PD, but mainly in glial cells as cytoplasmic inclusions . In contrast, PSP and corticobasal degeneration are referred to as tauopathies due to characteristic intraneuronal tau aggregation and some TDP-43 proteinopathies might also develop clinical parkinsonism .
In this context, technical tests might further improve the quality of differential diagnosis. Autonomous tests, such as tests for cardiovascular, urinary, thermoregulatory or gastrointestinal dysfunction can be helpful for the diagnostic differentiation PD versus AP. Due to a marked overlap, the combination of several tests such as urodynamic investigation, tests for orthostatic dysregulation, RR-intervals and sympathetic skin response can contribute to support the correct diagnosis.
Hospice Eligibility For Parkinsons Disease
Due to the progressive nature of Parkinsons disease, it can be challenging for families to know when their loved one is eligible for the support of hospice care. If a loved one has been diagnosed with six months or less to live or if they have experienced a decline in their ability to move, speak, or participate in the activities of daily living without caregiver assistance, it is time to speak with a hospice professional about next steps.
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Parkinsons Disease Treatment And Its Future
Parkinsons disease has no cure. However, millions of dollars are going into research every year to help better understand the disease, from how its defined to how its treated. The ultimate end goal is developing a cure for Parkinsons, but in the meantime, doctors and researchers have developed treatment plans based on what they presume is causing the disease in the first placemost often the lack of certain brain chemicals and cells like dopamine.
The plans vary per patient, and some of these treatment options include:
There isnt any real way to definitively prevent the disease, either. As with prevention for any disease or malady, its suggested that you maintain a healthy lifestyle before and after a diagnosis. Remaining physically engaged through activities like running, yoga, and weight lifting and eating healthy are both ways to provide your body with the best opportunity for a healthy life.
Clinical trials are also viewed as a treatment option because they may give you as good of a chance of relieving symptoms as other already-existent treatments. There are clinical trials happening year-round with various institution and foundations, and your demographic may fit a trial in its beginning pre-clinical stage or an advanced stage.
Talk to your doctor about any available clinical trials that you may qualify for and how to become a part of them. Also stay in contact with your doctor regarding any concerns that you may have with Parkinsons or how to get it treated.
Stages Of Parkinsons Disease
Because Parkinsons disease develops over time, there are various stages that help identify how symptoms have progressed and what should be expected next.
Generally, doctors follow a set of five stages as outlined below:
The beginning stage of Parkinsons disease sometimes doesnt show any signs at all. If symptoms are noticeable, theyre usually tremors and affect one side of the body. The symptoms usually dont affect your daily routine, but they should be taken seriously and brought to the attention of your doctor, if they havent already.
During this stage, the disease starts to affect your whole body. The tremors and stiffness cause routine activities to take a little longer to complete, and your overall movement starts to be affected. Your posture and facial expressions may should start to change, which can impact your ability to walk at a normal pace or communicate like you used to.
This stage features a worsening of all the symptoms that started to progressively deteriorate in stage 2, but you also start to experience a loss of balance and coordination, as well as how quick your reflexes are. As these symptoms start to come into the fold, people with the disease start to fall more, which can cause their own injuries and debilitations. Activities like getting out of bed, eating, and getting dressed start to get more difficult.
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Signs Of Parkinsons Disease
In 1817, Dr. James Parkinson published An Essay on the Shaking Palsy describing non-motor, as well as, motor symptoms of the illness that bears his name. Parkinsons is not just a movement disorder, explained Dr. Shprecher. Constipation, impaired sense of smell, and dream enactment can occur years before motor symptoms of Parkinsons. The latter, caused by a condition called REM sleep behavior disorder, is a very strong risk factor for both Parkinsons and dementia . This has prompted us to join a consortium of centers studying REM sleep behavior disorder.
Typical Timescale For Pdd
According to the Parkinsons Foundation, PDD is typically diagnosed when a person living with Parkinsons disease experiences cognitive decline after a year or more of motor symptoms. But in most cases, people experience many years of tremors, slowness of movement, and muscle cramps before showing signs of significant cognitive decline. The Weill Institute for Neurosciences estimates the average time from onset of movement problems to developing dementia is 10 years. An estimated 50% to 80% of people with Parkinsons will eventually experience Parkinsons disease dementia, says the Alzheimers Association.
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Unified Parkinsons Disease Rating Scale
The UPDRS contains four parts. The first part assesses intellectual function, mood, and behavior. The second one assesses activities of daily living. The third part assesses one motor function, and the fourth assesses motor complications.
Each part includes scores that altogether rate the severity of the disease. The maximum score is 199, reflecting total disability, whereas a score of zero means no disability.
Causes Of Parkinson’s Disease
Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.
Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.
Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.
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How Do Symptoms Progress
The most common symptoms of Parkinson’s are tremor, rigidity and slowness of movement.
Not everyone with Parkinson’s experiences the same combination of symptoms they vary from person to person.
Also, how Parkinson’s affects someone can change from day to day, and even from hour to hour. Symptoms that may be noticeable one day may not be a problem the next.
Many of the symptoms can be treated or managed with medication and therapies.
Many people with Parkinson’s lead active and fulfilling lives. An important part of coping with Parkinson’s is understanding how it affects you and how to work around it.
It may not always be easy to maintain a positive outlook, especially immediately after diagnosis. But we can give you help and support.
Parkinsons Disease: The Progression Of Symptoms
Many patients wonder how long their disease will take to progress to stage five. The truth is that there is no way to predict individual progression. These five Parkinsons disease stages are different for everyone. For some, it can take years to move from stage one to stage two for others, the disease can progress in a matter of months. Your doctor should be happy to answer any questions you have relating to the progression of your symptoms, but you can also make use of online resources, such as the ones listed below.
APA ReferenceSmith, E. . 5 Stages of Parkinsons Disease: Progression of Parkinsons, HealthyPlace. Retrieved on 2021, August 27 from https://www.healthyplace.com/parkinsons-disease/effects/5-stages-of-parkinsons-disease-progression-of-parkinsons
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Managing Symptoms In The End Stage Of Parkinsons
Because of the degenerative nature of the disease, patients in the end stage of Parkinsons are at severe risk of:
- Digestive Problems
To avoid serious complications, patients require 24-hour assistance. This includes:
- Shifting Them Every Two Hours. To prevent their weight from opening wounds on the skin.
- Toileting. Besides walking patients to the bathroom, caregivers need to help them undress and clean up afterwards.
- Changing Diapers. If the patient is confined to bed, their diapers need to be checked and changed every two hours to prevent excoriation .
- Bathing & Grooming. If the patient cannot get to the shower, the caregivers will need to give them a sponge bath. Patients will also need help trimming their nails, combing their hair, and brushing their teeth.
- Eating. Caregivers may have to push patients to eat, if they are able. Because of difficulties chewing and swallowing, soft foods may be all they can eat at this stage. Oatmeal, scrambled eggs, yogurt, applesauce, mashed potatoes, and smoothies are good choices. If you serve solid food, cut it into small pieces to prevent choking.
- Drinking. Patients need to drink 6-10 glasses of water a day to stay hydrated.
- Organizing Medication. Patients are usually prescribed several medications to reduce shakes and control movement. Medications need to be carefully organized and all caregivers need to be briefed on their instructions.
When is it Time for Hospice Care?
Practical Aspects For The Implementation Of Advanced Treatments
In the past few years, the treatment of PD has become increasingly complex and it is expected to be more individualized in the future, which implies novel strategies for best practices to define and convey best treatment options to patients with advPD. Current guidelines are a helpful tool in the diagnostics and therapeutic decision making in the early stages of disease however, there is not enough reliable information on how to implicate the suggested strategies in the everyday neurological practice. In addition, there is little specific information on possibilities of influencing the course of disease progress. In addition to the usage of the oral medication in the early stages of the disease, there has been an increase in application of the interventional therapies such as deep brain stimulation and pump therapies. These highly specific treatment options are mostly implemented in specialized clinics or practices for movement disorders. Here, the optimal timing for initiating advanced therapies to improve the quality of life and prevent complications is critical and requires an early information of patients and caregivers about the later stages of the disease with its complications.
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