The 5 Stages of Parkinson’s Disease Explained (2024)

As the condition advances, the severity of symptoms progress.Doctors may use a rating scale to stage Parkinson’s disease.Parkinson’s disease is a progressive neurological disorder that causes part of the brain that produces dopamine to deteriorate. There are other changes as well, some of which contribute to dementia.

Because dopamine plays an important role in helping the body move, four key symptoms relate to motion:

• tremors
• muscle stiffness
• slowness of movement
• coordination deficit

Not everyone with this condition experiences it the same way. Differences can make it difficult to know what to expect. Still, some clinicians divide the progression into five stages based on the severity of the key symptoms.

Keep reading about how this condition advances and treatments that may slow the progression.

Doctors use multiple scales to assess the severity and progression of Parkinson’s disease. Some physicians use the Movement Disorder Society’s Unified Parkinson’s Disease Rating Scale. It’s a tool to assess and score the symptoms and their effect on function and daily living.

The scale that describes the five stages of Parkinson’s disease is the Hoehn and Yahr scale. Researchers developed it in ​​1967 to describe the early, middle, and late stages of Parkinson’s disease.

There is no set rule for how long each stage in the Hoehn and Yahr scale lasts. However, researchers published a 2010 study that indicates the median length is:

• 20 months between stages 1 and 2
• 87 months between stages 2 and 3
• 24 months between stages 3 and 4
• 26 months between stages 4 and 5

This condition’s rate varies depending on the location and pace of nerve loss.

The following section describes each of the stages in the Hoehn and Yahr scale.

During the first stage of Parkinson’s disease, the symptoms:

• are mild and occur only on one side of the body
• may include changes in facial expressions
• may include changes in posture and walking patterns
• involve tremor

This stage usually does not impact daily life. Because the symptoms in this stage are subtle, Parkinson’s disease can go unnoticed until stage 2. The symptoms respond effectively to medication at this stage.

Movement issues include both sides of the body, and stiffness may occur in the neck and waist.

The symptoms become more noticeable, and completing daily tasks may take longer and feel more difficult.

Walking issues are more common at this stage. So, rearranging the home to make frequently used items more accessible and clearing tripping hazards can help cope with the changes and avoid accidents, such as falls.

People at stage 3 can still live independent lives, but completing daily tasks becomes more challenging.

One key sign of stage 3 is balance issues. When the person stands, it may feel like someone is pushing them, which tends to cause falls.

The symptoms that began in stages 1 and 2 continue to worsen.

Doctors often prescribe a combination of medication and occupational therapy to ease symptoms and simplify activities of daily living.

Learn what occupational therapists do.

This stage is a turning point in Parkinson’s disease progression. The symptoms are fully developed and create a severe disability.

People at this stage are unable to live alone safely. They have slower reflexes, and although they may still be able to walk, a cane or walker can prevent falls.

Read about assistive devices that can help with walking.

At this stage, the person may experience such significant leg stiffness that they can no longer stand or walk and need a wheelchair. They also experience severe posture issues.

Around-the-clock care is necessary.

Parkinson’s disease symptoms can become less responsive to medications at this stage. Confusion and hallucinations are also possible.Learn more about hallucinations.

While Parkinson’s disease does not cause people to die, it can increase the chance of life threatening complications such as lung infections.

People with Parkinson’s disease can have a near-typical life expectancy, based on a 13.5-year follow-up of 182 people with Parkinson’s disease. In the study, people with typical cognitive function lived longer than those who experienced a decline in cognitive function or dementia within 3 years of diagnosis.

Learn about Parkinson’s disease dementia.

There is currently no test Trusted Source National Institute on Aging Governmental authority Go to source that can confirm a Parkinson’s disease diagnosis. The exception is when testing points to a clear genetic cause of Parkinson’s.

Doctors diagnose Parkinson’s disease and the stage based on symptoms and their effects.

According to the National Institute of Neurological Disorders and Stroke (NINDS), most people receive a diagnosis after losing an estimated 60–80% of the cells that produce dopamine in the substantia nigra region, which is in the midbrain.

Evaluating the stage of Parkinson’s disease can help the care team create a treatment plan. Knowing the stage and what they might expect helps some people cope and plan.

To receive a Parkinson’s disease diagnosis, a person must experience slowness of movement and at least one other motor symptom.

However, people who display symptoms associated with a higher likelihood of developing Parkinson’s disease may be in the prodromal phase of the disease.

A few of these symptoms, often referred to as “non-motor symptoms,” include:

• hyposmia, which is the reduced ability to smell
• constipation
• anxiety or depression or both
• REM sleep behavior disorder

This is in contrast to the preclinical phase of Parkinson’s disease, in which people are not experiencing symptoms, but the loss of dopamine-producing cells has begun. Doctors may detect such changes with nuclear imaging tests.

Researchers continue to study medications and therapies with the hope of slowing progression.

Levodopa is a first-line medication that clinicians prescribe for Parkinson’s disease symptoms, but it does not slow disease progression, says the NINDS.

The body uses levodopa to produce dopamine. Doctors often prescribe it alongside carbidopa, a medication that reduces the negative side effects of levodopa.

Deep brain stimulation (DBS) is a surgical treatment option for people who do not respond well to or are not candidates for medication. This surgery targets the movement symptoms of Parkinson’s disease.

The NINDS states that DBS “does not stop PD from progressing.” However, a 2020 study Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source showed that DBS “decreases the risk of disease progression” in a trial of people with early-stage Parkinson’s disease. Over a 5-year study period, people receiving DBS were less likely to need increasingly higher doses of levodopa to manage symptoms.

Doctors prescribe medications and lifestyle practices to help with other symptoms of Parkinson’s disease.

Learn more about Parkinson’s disease treatments.

Nancy Hammond, M.D., reviewed the following questions.

Stage 5 is the final stage of Parkinson’s disease. At this stage, a person requires constant assistance and cannot stand or walk on their own.

Sudden and unexpected death is rare Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source but possible in Parkinson’s disease. Sudden deterioration is also uncommon because the disease typically progresses slowly.

People with Parkinson’s disease but without dementia have a near-typical life expectancy. However, research suggests that people with early-onset Parkinson’s disease have a shorter life expectancy than people who develop it later.

Learn more about Parkinson’s disease prognosis.

The Hoehn and Yahr scale divides Parkinson’s disease into 5 stages. These stages describe the symptoms, and their effects on daily living as Parkinson’s disease progresses. Doctors may use this scale to evaluate and create a treatment plan.

To determine the stage, a doctor will ask you about symptoms and how they affect function. They will also conduct a physical exam.

Parkinson’s disease medications cannot slow progression, but there is some evidence that DBS may slow it. Clinical trials of drugs that may slow disease progression Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source are ongoing.