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Although Parkinson's disease symptoms — as well as their severity and the order in which they appear — vary from patient to patients, some generalizations can be made about patterns. The stages of Parkinson's are based on these.
Parkinson’s disease is a degenerative neurological movement disorder that doesn't affect life expectancy but can severely impact patients' quality of life. Most people will be at least slightly familiar with some of its most characteristic symptoms — involuntary shaking (tremors), trouble maintaining balance, finding it difficult to stand up, slowness of movement (bradykinesia), and stiffness.

Patients may barely take notice of some of the earlier signs of Parkinson's disease, like mild tremors in a finger, stiffness, constipation, and a gradual loss of the sense of smell — which they may attribute to increasing age or temporary illness. As time passes, more worrying new symptoms will make an appearance, and patients may find it difficult to engage even in tasks they previously took for granted, like speaking and even smiling.

What do you need to know about rating scales for Parkinson's disease?

Although Parkinson's disease symptoms, and the way in which they progress, will differ from patient to patient, the condition does tend to have predictable patterns. It is in accordance with these patterns that the stages of Parkinson's disease were developed. Doctors have access to more than one rating scale to measure the way in which Parkinson's disease progresses. These rating scales may solely focus on how the condition has affected the patient's motor skills, or also include other symptoms, such as gastrointestinal symptoms and the patient's sense of smell. 

  • The Hoehn and Yahr scale has been used since the 1960s, looks at motor symptoms, and uses a scale of severity from one (least severe) to five (most severe). 
  • The newer United Parkinson’s Disease Rating Scale (UPDRS) looks far beyond motor symptoms, also measuring the patient's mood and cognition, and how intensely their everyday life is affected by Parkinson's disease. This more comprehensive scale is now most frequently used.
(Potential) patients and their loved one will benefit from understanding it better, as an evaluation based on this scale has many sections:
  • Part I looks at mental ability, behavior, and the patient's mood.
  • Part II explores the patient's ability to carry out everyday activities — it looks at their speech, handwriting, ability to swallow and produce saliva, sleep patterns, and ability to engage in personal hygiene tasks and every day things such as getting dressed and cutting food. This part also examines how well patients can walk and whether they have struggled with falls. This part is based on the patient's on reports.
  • Part III is a motor evaluation carried out by the doctor.
  • Part IV looks at complications the patient has experienced as a result of their therapies
  • Part V uses the Hoehn and Yahr scale
  • Part VI, finally, uses the Schwab and England ADL scale
This comprehensive diagnostic and measuring process is important, as not all Parkinson's patients will experience the same symptoms, and nor do symptoms always arrive in a neat, predetermined, pattern. Severity is also individual. Some generalizations can be made about the features of Parkinson's disease at each stage, which is why stages can offer helpful insights. 

Parkinson's disease: Stage 1

The first and mildest stage, Stage 1 of Parkinson's disease can easily be missed or dismissed as having some other cause — like getting older, being tired, or a temporary illness. Symptoms are present but not so intense that they impact a person's day-to-day functioning. Where motor symptoms strike, they do so on only one side of the body. Medications can be used to manage symptoms quite effectively at this stage. The signs of Parkinson's at this stage can include:

  • Tremors (shaking)
  • Stiffness
  • A slowing down of movement within the arms or legs, which may affect the person's gait
  • Changed facial expression, again on one side of the face

Parkinson's Disease: Stage 2

Though still fairly mild compared to later stages, patients with Stage 2 Parkinson's will start to have more invasive symptoms than in Stage 1. The symptoms become bilateral, affecting both halves of the body, and this can happen months, but also years, after initial symptoms announced themselves.

Stage 2 Parkinson's patients (and those around them) may notice:

  • Speech becomes more of a challenge — slurred speech, changes in volume (a softer, less audible, voice), and monotonous speech are all possible.
  • Facial expression is affected on both sides of the face, and the patient may have trouble blinking.
  • Stiff muscles, especially around the torso, lead to increased back and neck aches and an unhealthy posture. This also prevents the patient from carrying out activities, including simply moving their limbs, as quickly as they used to be able to.
  • Tremors (shaking) become more severe and harder to ignore.
  • Balance is not yet a problem.

Due to the increasingly noticeable symptoms, patients who were never diagnosed with Stage 2 are easier to identify at this point, particularly if they have tremors, the most characteristic symptom of Parkinson's. Symptoms can occasionally still be dismissed as being caused by aging. Independent living becomes harder at this stage, but most people find they can still function, albeit with more difficulty.

Parkinson's disease: Stage 3

Stage 3 patients will continue to experience all the symptoms they had in Stage 2. They will also have some additional difficulties:

  • Difficulty in maintaining balance, making falls more likely
  • A more pronounced slowing down of movement. 
  • Slower reflexes.

Stage 3 patients are still able to engage in everyday tasks, but with increasing difficulty, and they can benefit from a combination of medications and occupational therapy to maximize their quality of life at this point. 

Parkinson's disease: Stage 4

By the time a patient reaches Stage 4 Parkinson's, the condition has a very marked impact on their quality of life and ability to engage in daily activities. Walking and even standing can become a challenge, and in addition to medications and occupational therapy, they may now require a walker, a walking stick, or other aids that help them maintain their balance. Independent living can become a real danger at this stage, and patients will require help in completing daily tasks.

Parkinson's disease: Stage 5

This most advanced stage of the disease features all the same symptoms experienced in previous stages, with the addition that the legs of Stage 5 patients can be so stiff that they find themselves unable to walk, or even stand up, without the very real risk of falling. Stage 5 Parkinson's necessitates the use of a wheelchair and extensive help in completing everyday tasks. Independent living is no  longer possible. Medications, meanwhile, are no longer as effective, and their side effects may mean that no longer using them becomes the better choice.

It is important to note that nearly a third of Parkinson's patients will have cognitive symptoms as well. These symptoms are closely associated with dementia, which affects the vast majority of patients in Stage 5:

  • Confusion
  • Delusions
  • Hallucinations

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