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What Are the Five Stages of Parkinson’s Disease?

Parkinson's disease is a neurodegenerative disorder with symptoms that get worse over time. There are five stages of Parkinson's disease, which range from mild movement symptoms to needing around-the-clock nursing care.
Parkinson's disease is a neurodegenerative disorder with symptoms that get worse over time. There are five stages of Parkinson’s disease, which range from mild movement symptoms to needing around-the-clock nursing care.

Parkinson's disease is a neurodegenerative, chronic movement disorder that progressively worsens over time.

Parkinson’s disease usually progresses in some typical patterns, though not every patient will experience all the symptoms at the same time, in the same way, or with the same severity. 

There are five stages of Parkinson’s disease, which are explained in the table below.

The Five Stages of Parkinson’s Disease Chart
Stage Symptoms
Stage One
  • Mild symptoms that usually do not interfere with daily activities
  • Tremor and other movement symptoms occur only on one side of the body
  • Changes in posture, walking, and facial expressions occur
Stage Two
  • Symptoms worsen
  • Tremor, rigidity, and other movement symptoms affect both sides of the body
  • Problems walking and poor posture
  • Person is able to live independently, but daily tasks become more difficult and time-consuming

Stage Three
  • Considered mid-stage
  • Characterized by loss of balance and slowness of movements 
  • Falls are more common
  • Person is still able to live independently, but everyday activities such as dressing and eating become more difficult due to symptoms

Stage Four
  • Symptoms have become severe and limiting
  • Standing without assistance may be possible, but movement may require a walker
  • People need help with daily activities and are unable to live alone
Stage Five
  • The most advanced stage and patients need around-the-clock nursing care 
  • Patients are severely disabled and unable to stand or walk
  • The person requires a wheelchair or is bedridden 
  • Hallucinations and delusions may occur

What Causes Parkinson’s Disease?

The cause of Parkinson’s disease is not fully understood but it is believed to be due to a combination of genetic and environmental factors. 

  • Genetics are responsible for about 10% to 15% of all cases of Parkinson's disease
  • Environmental factors associated with an increased risk of developing Parkinson's disease include: 
  • Traumatic brain injury
  • Area of residence
  • Certain occupations
  • Exposure to pesticides
  • Increased age: About 1% of people over age 60 have Parkinson's disease
  • Gender: more common in men than in women

How Is Parkinson’s Disease Diagnosed?

Parkinson's disease is diagnosed with a detailed patient history, including the presence of two of the four main symptoms over a period of time:

  • Shaking or tremor
  • Slowness of movement (bradykinesia)
  • Stiffness or rigidity of the arms, legs or trunk
  • Trouble with balance and possible falls (postural instability)

What Is the Treatment for Parkinson’s Disease?

There is currently no cure for Parkinson’s disease. Treatment for each person with Parkinson's disease is based on symptoms and may include medications to manage symptoms, surgery, and lifestyle modifications.

Medications used to treat Parkinson’s disease symptoms include: 

  • Levodopa
    • Carbidopa/levodopa immediate-release tablets (Sinemet, Parcopa, Duopa, Rytary)
    • Carbidopa/levodopa/entacapone tablets (Stalevo)
  • Dopamine agonists
    • Pramipexole (Mirapex, Mirapex ER)
    • Ropinirole (Requip, Requip XL)
    • Apomorphine hydrochloride (Apokyn, Kynmobi)
    • Rotigotine transdermal system (Neupro)
  • Amantadine (Symmetrel, Gocovri, Osmolex ER)
  • Adenosine A2a antagonists
    • Istradefylline (Nourianz)
  • COMT inhibitors
    • Entacapone (Comtan)
    • Tolcapone (Tasmar)
    • Carbidopa/levodopa/entacapone tablets (Stalevo)
    • Opicapone (Ongentys)
  • Anticholinergic Drugs
    • Benztropine (Cogentin)
    • Trihexyphenidyl HCL (formerly Artane)
  • MAO-B Inhibitors
    • Selegiline (l-deprenyl, Eldepryl, Zelapar)
    • Rasagiline (Azilect) 
    • Safinamide (Xadago)

Surgery for Parkinson’s disease is reserved for patients for whom medical treatment of tremor was not successful or for patients who suffer profound motor fluctuations (wearing off and dyskinesias). Surgical treatments for Parkinson’s disease include:

  • Deep brain stimulation (DBS) 
  • Surgery performed to insert a tube in the small intestine, which delivers a gel formulation of carbidopa/levodopa (Duopa)

Other treatments for Parkinson’s disease include: 

  • Getting adequate rest
  • Exercise
    • Aerobic activity 
    • Strength training
    • Balance, agility, and multitasking
    • Flexibility
  • Physical therapy
  • Occupational therapy
  • Medical marijuana
  • Over-the-counter (OTC) and complementary therapies
  • Antioxidants: Vitamin C and E
    • Mediterranean Diet
    • Most herbs and supplements have not been rigorously studied as safe and effective treatments for PD
    • The U.S. Food and Drug Administration (FDA) does not strictly regulate herbs and supplements
    • There is no guarantee of safety, strength, or purity of supplements not monitored by the FDA
    • Talk to your doctor before using any herbal or alternative remedy

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References
https://www.parkinson.org/