What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms; others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
Young Onset Parkinsons : An Introduction
Although the average age to develop Parkinsons is around 60, young onset Parkinsons occurs in 5-10% of people diagnosed. 20% are under the age of 50. Some challenges in Parkinsons are universal, regardless of age, but there are a number of issues specific to younger people.
Generally, Parkinsons proceeds more slowly in younger people. While no two people are the same, someone whose onset age is 40 can expect to work for another 15-20 years on average. For someone with an onset age of 60, the average figure would be half that. These figures are based on the kinds of treatment available today. Future treatment will be even more effective in prolonging the productive life of people with Parkinsons.
Larry Gifford hosts a panel discussion on Living Well with Young Onset Parkinsons in May of 2020.
The following characteristics tend to be present in young onset Parkinsons:
- Young onset Parkinsons is less likely to lead to dementia and balance problems
- It is more likely to include focal dystonia, which is cramping or abnormal posturing of one part of the body.
- Younger people are more sensitive to the benefits of Parkinson medications, but they tend to experience the dyskinetic side effects of levodopa sooner than older people.
- They also tend to experience dose-related fluctuations at an earlier stage of the disease, including wearing off* and the on-off effect. See Parkinson Canada Information Sheet,;Parkinsons Medications: What you need to know!
Parkinsons Disease Is A Progressive Disorder
Parkinsons Disease is a slowly progressive neurodegenerative disorder that primarily affects movement and, in some cases, cognition. Individuals with PD may have a slightly shorter life span compared to healthy individuals of the same age group. According to the Michael J. Fox Foundation for Parkinsons Research, patients usually begin developing Parkinsons symptoms around age 60. Many people with PD live between 10 and 20 years after being diagnosed. However, a patients age and general health status factor into the accuracy of this estimate.
While there is no cure for Parkinsons disease, many patients are only mildly affected and need no treatment for several years after their initial diagnosis. However, PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time. This progression occurs more quickly in some people than in others.
Pharmaceutical and surgical interventions can help manage some of the symptoms, like bradykinesia , rigidity or tremor , but not much can be done to slow the overall progression of the disease. Over time, shaking, which affects most PD patients, may begin to interfere with daily activities and ones quality of life.
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Eat Healthy Meals Throughout The Day
- Consuming a variety of foods from all;five food groups provides;consistent energy and keeps your immune system healthy. Focus on eating a minimum of five fruits and vegetables each day, eating a variety of high fiber foods, and staying hydrated, all of which help prevent constipation, which is often an issue for people diagnosed with YOPD.
- Watch this to learn how to use nutrition to help you live well with Parkinsons.
Trouble Moving Or Walking
Do you feel stiff in your body, arms or legs? Have others noticed that your arms dont swing like they used to when you walk? Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinson’s disease. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem stuck to the floor.
What is normal?If you have injured your arm or shoulder, you may not be able to use it as well until it is healed, or another illness like arthritis might cause the same symptom.
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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.
Incidence Of Parkinsons Disease
Its estimated that approximately four people per 1,000 in Australia have Parkinsons disease, with the incidence increasing to one in 100 over the age of 60. In Australia, there are approximately 80,000 people living with Parkinsons disease, with one in five of these people being diagnosed before the age of 50. In Victoria, more than 2,225 people are newly diagnosed with Parkinsons every year.
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Is Early Diagnosis Possible
Experts are becoming more aware of symptoms of Parkinsons that precede physical manifestations. Clues to the disease that sometimes show up before motor symptoms and before a formal diagnosis are called prodromal symptoms. These include the loss of sense of smell, a sleep disturbance called REM behavior disorder, ongoing constipation thats not otherwise explained and mood disorders, such as anxiety and depression.
Research into these and other early symptoms holds promise for even more sensitive testing and diagnosis.
For example, biomarker research is trying to answer the question of who gets Parkinsons disease. Researchers hope that once doctors can predict that a person with very early symptoms will eventually get Parkinsons disease, those patients can be appropriately treated. At the very least, these advances could greatly delay progression.
Parkinson’s Disease and Movement Disorders Center
Our center provides compassionate and timely treatment to patients with movement disorders, such as dystonia, ataxia, essential tremor and similar conditions. But our mission goes beyond patient care excellence. By offering educational events and support groups, we empower patients and caregivers to become better partners in their health.
Causes Of Parkinsons Disease In Seniors
Parkinsons Disease affects the section of the brain called the substantia nigra pars compacta, and it controls muscle movement and produces dopamine. Without dopamine, muscle movements become jerky or difficult to control.Scientists believe the disease is more common in seniors based on a combination of genetic and environmental factors. As people age, the processes imperative to the function of substantia nigra neurons begin to decline. Based on an article by Reeve, Simcox, & Turnbull , the following causes cell death of the substantia nigra neurons:
- Accumulation of mitochondrial DNA defects
- Oxidative damage
- Accumulation of neuromelanin
These stressors can weaken the neurons significantly. Although it is unknown why, mitochondrial dysfunction and changes to the protein degradation pathways are more detrimental to the neurons in the substantia nigra than anywhere else in the brain.
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Surgery And Deep Brain Stimulation
Deep brain stimulation is a treatment for Parkinsonâs disease that uses an implantable pacemaker-like device to deliver electrical pulses to parts of the brain involved in movement. The DBS system consists of leads precisely inserted into a specific brain target, the neurostimulator implanted in the chest, and extension wires that connect the leads to the neurostimulator. Though implantation of the system requires a neurosurgical procedure, the treatment itself consists of long-term electrical stimulation. Advantages of DBS include its ability to reduce the high doses of medications , its adjustability , and its reversibility DBS was approved by the Food and Drug Administration as a treatment for PD in 2002 and according to Medtronic , more than 80,000 patients have undergone DBS surgery worldwide.
Typical candidates are those who have motor fluctuations or periods of âoffâ time with troublesome symptoms alternating with periods of âonâ time with good symptom control, and also with possible periods of excessive movement .
Not all patients with Parkinsonâs disease are good candidates for treatment with DBS. Approximately 10â20% of patients considered for possible treatment with DBS include those:
Surgery For People With Parkinsons Disease
Deep brain stimulation surgery is an option to treat Parkinsons disease symptoms, but it is not suitable for everyone. There are strict criteria and guidelines on who can be a candidate for surgery, and this is something that only your doctor and you can decide. Surgery may be considered early or late in the progression of Parkinsons.;When performing deep-brain stimulation surgery, the surgeon places an electrode in the part of the brain most effected by Parkinsons disease. Electrical impulses are introduced to the brain, which has the effect of normalising the brains electrical activity reducing the symptoms of Parkinsons disease. The electrical impulse is introduced using a pacemaker-like device called a stimulator.;Thalamotomy and pallidotomy are operations where the surgeon makes an incision on part of the brain. These surgeries aim to alleviate some forms of tremor or unusual movement, but they are rarely performed now.
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How Is Parkinsons Diagnosed
Doctors use your medical history and physical examination to diagnose Parkinson’s disease . No blood test, brain scan or other test can be used to make a definitive diagnosis of PD.
Researchers believe that in most people, Parkinson’s is caused by a;combination of;environmental and genetic;factors. Certain environmental exposures, such as pesticides and head injury, are associated with an increased risk of PD. Still, most people have no clear exposure that doctors can point to as a straightforward cause. The same goes for genetics.;Certain genetic mutations are linked to an increased risk of PD. But in the vast majority of people, Parkinsons is not directly related to a single genetic mutation. Learning more about the genetics of Parkinsons is one of our best chances to understand more about the disease and discover how to slow or stop its progression.
Aging is the greatest risk factor;for Parkinsons, and the average age at diagnosis is 60.;Still, some people get PD at 40 or younger.
Men are diagnosed with Parkinsons at a higher rate than women and whites more than other races. Researchers are studying these disparities to understand more about the disease and health care access and to improve inclusivity across care and research.;
Aging is the greatest risk factor;for Parkinsons, and the average age at diagnosis is 60.;Still, some people get PD at 40 or younger.
The Michael J. Fox Foundation has made finding a test for Parkinsons disease one of our top priorities.
Treatment Options For Early Onset Parkinsons Disease
Parkinsons treatment aims to slow the diseases progression. Medication treatment options may include the following:
- Levodopa is a chemical thats converted to dopamine in the brain. People with early onset Parkinsons may experience more negative side effects, such as involuntary movements.
- MAO-B inhibitors can help reduce the breakdown of dopamine in the brain.
- Catechol-O-methyltransferase inhibitors can help extend Levodopas effects on the brain.
- Anticholinergics can help reduce tremors.
- Amantadine may be used to improve muscle control and relieve stiffness.
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What Is Parkinsons Disease
Parkinsons disease is a progressive brain disorder that affects mobility and mental ability. If you or a loved one has been diagnosed with Parkinsons, you may be wondering about life expectancy.
According to some research, on average, people with Parkinsons can expect to live almost as long as those who dont have the condition.
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.
Diagnosing Early Onset Parkinsons Disease
There is no single test to detect Parkinsons. A diagnosis may be difficult and take a while. The condition is usually diagnosed by a neurologist based on a review of your symptoms and a physical exam.
A DaTscan to visualize your brains dopamine system may help confirm diagnosis. Blood tests and other imaging tests, such as an MRI scan, dont diagnose Parkinsons. However, they may be used to rule out other conditions.
Take Care Of Yourself
Probably one of the most important, and sometimes difficult, things caregivers can do is to take care of themselves. This includes maintaining mental and physical health by making and keeping your own medical and dental appointments. As a caregiver, it is important to keep your job whenever possible as it provides not only financial help and possibly insurance coverage, but also a sense of self-esteem. Join a support group;for caregivers;if possible. Support groups help you meet people who are going through what you are going though, vent frustrations, give and receive mutual support, and exchange resource information and coping strategies. Whenever possible get your sleep, take breaks, make and keep social activities, and try to keep your sense of humor.
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New Diagnostic Standards For Parkinsons
Until recently, the gold-standard checklist for diagnosis came from the U.K.s Parkinsons Disease Society Brain Bank. It was a checklist that doctors followed to determine if the symptoms they saw fit the disease. But thats now considered outdated. Recently, new criteria from the International Parkinson and Movement Disorder Society have come into use. This list reflects the most current understanding of the condition. It allows doctors to reach a more accurate diagnosis so patients can begin treatment at earlier stages.
Make An Appointment With A Physical Therapist Or Occupational Therapist
- One of the most common phrases we hear from people with Parkinsons is, I wish I had seen a physical therapist sooner. Doing your daily exercise program isnt enough. Physical therapists and occupational therapists create individualized exercises that meet your specific needs. The activities they recommend can improve your posture, gait, arm swing, and other movement challenges.
- to find a Parkinsons PT in your area.
- to learn why youll want to work with a Parkinsons OT.
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Symptoms Of Parkinsons In Women
Premenstrual symptoms of depression, bloating, weight gain and breast tenderness also appear to increase in intensity in women who note a variation in their symptom control with menstruation. Usually these symptoms improve after menstruation but will reoccur with each cycle. A small sample of women in the studies used birth control pills. They reported that they had less intense fluctuations in their symptom control but more research needs to be done before recommendations can be made. However, it is important to recognize that these fluctuations occur so that women can be prepared for the changes in control. The use of regular exercise and relaxation techniques can help decrease symptoms and improve coping abilities.
Early Onset/young Onset Parkinson’s
Parkinsons can occur at any;age. Early onset Parkinson’s, also known as young onset Parkinsons , is defined as occurring in someone below the age of 40. Research suggests that genetics may play more of a role in early or young onset than in people who are diagnosed over the age of 40.
In early or young onset Parkinson’s,;the symptoms you experience and how you respond to medication may differ slightly from older onset, although for some people these can be very similar.
Motor symptoms generally respond well to medication in both young;and older onset Parkinsons. In early or young onset,;motor fluctuations such as;dyskinesia; and;wearing off; tend to occur earlier but they generally progress more slowly. This is thought to be due to the most commonly prescribed medication, levodopa, and for this reason, young onset;is usually treated initially with alternatives to levodopa such as MAO-B inhibitors or dopamine agonists.;Levodopa is generally only added in when other medications do not provide adequate symptom control.;
Dystonia; is also a more common early motor symptom in early or young onset, whereas some of the non-motor symptoms that occur in older onset Parkinsons, such as memory problems, are less common.
Deep brain stimulation has also been shown to be effective at an earlier stage of Parkinsons if medication no longer controls motor symptoms so well, and you may want to discuss this option with your care team. See;Deep brain stimulation.