Parkinson’s Disease Stages unfold gradually, beginning with mild, often unnoticed symptoms, and advancing to impaired movement, balance, and daily function. Global estimates show that over 10 million individuals live with this chronic neurological condition, with symptoms typically emerging after the age of 50. Understanding the distinct stages of Parkinson’s disease enhances medical care and supports tailored treatment plans that slow progression and preserve quality of life.
What is Parkinson’s disease?
Parkinson’s disease is a progressive disorder of the central nervous system that mainly affects movement, and is caused by the loss of dopamine-producing neurons in an area of the brain called the substantia nigra. Parkinson’s disease has no specific cause, but there are some predisposing factors, such as aging, the presence of genetic factors (family history of the disease), and some environmental factors (pesticides), that play a role in the onset of the disease. The symptoms of Parkinson’s disease begin to appear gradually, and they include motor and non-motor symptoms, namely:
- Motor symptoms
- Tremors: Involuntary shaking of the limbs
- Slowness of movement: Difficulty initiating movement
- Muscle rigidity: Stiffness of the trunk and limbs
- Imbalance: Difficulty standing and walking
- Non-motor symptoms
- Constipation
- Sleep problems
- Depression and anxiety
- Memory problems
- Disorders of the sense of smell
These symptoms appear gradually rather than all at once, and worsen as the disease progresses. The complications of these symptoms may eventually lead to death, so it is necessary to follow up on the disease and try to treat it.
Classification of Parkinson’s disease stages
Parkinson’s disease stages are divided into 5 levels according to the Hoehn and Yahr scale, with symptoms starting mildly in the first stage and peaking in the fifth stage.
First stage
In this stage, symptoms appear on only one side of the body (unilateral), such as the right hand, but not the left, and this stage is considered the beginning of Parkinson’s disease. It can last for several years.
Preventive CNS treatment should be prescribed at this stage to minimize nerve cell damage, prolong this stage, and delay the onset of the next stage as much as possible.
Second stage
This stage of the disease is called the bilateral stage, as in this stage, the symptoms begin to appear on both the right and left sides of the body, and the patient is diagnosed with the second stage as soon as any of the symptoms of the disease, no matter how mild, appear on the other side of the body.
Third stage
The third stage of Parkinson’s disease stages begins when symptoms of loss of balance begin to appear. The patient in this stage is unable to maintain his body’s straightness and posture, so his balance decreases, he has difficulty standing and walking, and he may sometimes fall while walking regularly.
Fourth stage
This stage is considered a milestone in the development of the disease’s symptoms, as at this stage the symptoms increase dramatically, the patient becomes unable to balance at all, and may lose the ability to walk, requiring constant care and accompaniment. At this stage, it is possible to resort to treatment with Deep Brain Stimulation (DBS) surgery, which significantly helps in alleviating the symptoms of the disease.
Fifth stage
The final stage of Parkinson’s disease is characterized by the patient losing the ability to walk independently, often leading to reliance on a wheelchair for mobility. At this stage, severe muscle stiffness becomes prevalent, and the patient typically requires permanent care.
How is the stage of the disease determined?
Knowing which stage of Parkinson’s disease a patient is in helps with treatment and symptom relief, so it is important for the doctor to accurately determine the stage of the disease using several methods, including:
- Hoehn and Yar Scale
- The Unified Parkinson’s Disease Rating Scale: This scale is the most detailed scale for assessing different aspects of the disease, and doctors rely on it in research and specialized clinics. It consists of 4 main sections, where each section is given a numerical score and then calculated to determine the severity of the disease and compare its progression over time, and these sections are:
- Mental state, behavior, and mood
- Activities of daily living
- Motor symptoms (such as tremor, slowness of movement, and stiffness)
- Complications resulting from treatment
- Supportive staging tests: Although clinical diagnosis comes first, there are some tests that can help assess the stage more accurately
- Gait and balance tests to measure movement speed and stability
- Dopamine imaging to assess dopamine cell loss in the brain
- Cognitive and psychological tests to evaluate advanced stages that may include cognitive impairment or depression
These scales and tests help determine the exact degree of the disease and are therefore considered the cornerstone of Parkinson’s treatment.
Can the progression of Parkinson’s disease stages be slowed down?
Although there is still no cure to stop the disease completely, it is possible to significantly slow the progression of Parkinson’s disease stages, improve motor and non-motor symptoms, and maintain the patient’s quality of life for as long as possible:
- Early and systematic drug treatment: Starting treatment in the early Parkinson’s disease stages helps to stabilize dopamine in the brain and significantly delay the progression of symptoms. The most important drugs used include:
- Levodopa: Converted in the brain to dopamine to compensate for the deficiency.
- Dopamine agonists: Stimulate dopamine receptors and delay the need for high doses of levodopa.
- COMT and MAO-B inhibitors: Slow down the breakdown of dopamine and prolong the effect of other medications.
- Deep Brain Stimulation (DBS): It works by implanting electrodes in certain areas of the brain (such as the subthalamic nucleus) to regulate abnormal nerve signals, and studies have proven that this procedure:
- Reduces the severity of tremors and slowness of movement.
- Allows for a reduction in medication dosage.
- Maintains motor function for a longer period.
- Physical therapy and regular exercise: Regular physical activity and exercise are key to counteracting the progression of Parkinson’s disease, as they:
- It improves blood flow to the brain and reduces nerve cell loss.
- It helps maintain flexibility and strength.
- It raises natural dopamine levels.
All of these treatments significantly help to slow the progression of Parkinson’s disease, alleviate symptoms, and may restore a person’s life and ability to be self-reliant in a significant way.
Living with Advanced Parkinson’s Disease
As Parkinson’s disease stages progress, the symptoms become more pronounced and complex. This progression often necessitates comprehensive medical and psychological care. Patients may experience difficulty walking and balancing, slower speech, and challenges with swallowing or fine motor skills. However, a good quality of life can be maintained by following a well-structured and consistent treatment plan.
Family and psychological support are pivotal factors in Parkinson’s disease stages, as they help alleviate the isolation and depression that may accompany the disease. Intensive physical and occupational therapy programs help maintain mobility and daily activities as much as possible. These programs also work to modify the home environment to facilitate mobility and prevent falls, such as removing floor obstacles and using assistive devices, such as crutches or a wheelchair, when needed.
Can Parkinson’s disease be cured?
With the development of medicine and biomedical engineering, the treatment of Parkinson’s disease has become highly feasible, as international hospitals provide many ways to stop the progression of Parkinson’s disease and significantly improve its symptoms. In some cases, it may even succeed in completely hiding the symptoms, and the most important treatments used include:
- Deep Brain Stimulation (DBS): This is one of the most prominent surgical techniques used to relieve motor symptoms that do not respond to medication, such as severe tremors or motor oscillations.
- Magnetic resonance-guided focused ultrasound (MRgFUS): This technique uses magnetic resonance-guided ultrasound to treat tremors or motor symptoms without the need for a full surgical incision or device implantation.
- Stem cell therapy: A type of regenerative therapy that aims to replace or repair damaged nerve cells in the brain (especially cells that produce dopamine) that are affected by Parkinson’s disease, helping to alleviate motor symptoms and significantly slow the progression of the disease.
Understanding Parkinson’s disease stages is a vital step in managing this complex neurological disorder, as each stage demands close monitoring and tailored medical care. In Turkey, Bimaristan Medical Center offers cutting-edge treatment solutions under the guidance of seasoned neurologists specializing in chronic neurological diseases. The center is dedicated to helping patients restore independence and enhance their quality of life through state-of-the-art technologies and comprehensive rehabilitation programs.
Sources:
- National Institute of Neurological Disorders and Stroke (NINDS). (2024). Parkinson’s Disease: Hope Through Research. U.S. Department of Health and Human Services.
- Johns Hopkins Medicine. (2023). Understanding Parkinson’s Disease.
