The Hoehn and Yahr Scale, published in 1967, describes five stages of the progression of Parkinson’s Disease across all patients.
Parkinson’s disease (PD) is progressive. It worsens over time. It also affects people in different ways. Symptoms may vary in their severity between patients. Not all people will experience all the symptoms. Symptoms may progress at different rates, as well. The list of five stages helps describe where a patient is in the progression of the disease.
The Five Stages Described
Stage One of Parkinson’s Disease – earliest stage
In the earliest stage, the symptoms are mild and only seen on one side of the body. There is usually minimal or no functional impairment. The symptoms of PD at stage one may be so mild that the person doesn’t seek medical attention. The physician may also be unable to make a diagnosis. Symptoms at stage one may include:
- tremor, such as intermittent tremor of one hand,
- or one hand or leg may feel more clumsy than another,
- or one side of the face may be affected, impacting the expression.
This stage is very difficult to diagnose. A physician may wait to see if the symptoms get worse over time before making a formal diagnosis. A physician may also order tests, such as an MRI, to rule out other possible causes.
Stage Two of Parkinson’s Disease – early disease
At Stage two symptoms appear on both sides of the body (bilateral involvement) or at the midline without impairment to balance. This stage may develop months or years after stage one.
Symptoms in stage two may include:
- the loss of facial expression on both sides of the face,
- decreased blinking,
- speech abnormalities such as
- soft voice,
- monotone voice,
- fading volume after starting to speak loudly,
- slurring speech
- stiffness or rigidity of the muscles in the trunk that
- may result in neck or back pain,stooped posture, and
- general slowness in all activities of daily living.
At this stage the individual is still able to perform tasks of daily living.
A diagnosis may be easy at this stage if the patient has a tremor.
It is also possible that the disease may be misdiagnosed as only advancing age. This could happen if the only symptoms are slowness or lack of spontaneous movement, and the stage one diagnosis of PD never occurred.
Stage Three of Parkinson’s Disease- mid-stage
Stage three occurs with loss of balance and slowness of movement. Balance falters due to the inability to make rapid, automatic and involuntary adjustments. Falls are common at this stage.
All other symptoms of PD are also present at this stage, and generally diagnosis is not in doubt.
Often a physician will stand behind the patient and pull the shoulders. This will determine if the patient has trouble maintaining balance. (The physician of course will not let the patient fall.)
There is an important distinction to make. At stage three, the patient is still independent in their daily living activities. The patient can still dress, practice hygiene, and eat without help.
Stage Four of Parkinson’s Disease – severely disabling disease
In stage four, the condition has progressed to a disabling disease. Patients with stage four PD may still be able to walk and stand unassisted. But they are incapacitated. Many use a walker to help them.
At this stage, the patient needs help with activities of daily living and cannot live an independent life. The necessity for help with daily living defines this stage. If the patient is still able to live alone, it is still defined as Stage Three.
Stage Five of Parkinson’s Disease – most advanced
Stage five is the most advanced, characterized by an inability to rise from a chair or get out of bed without help. They may have a tendency to fall when standing or turning, and they may freeze or stumble when walking.
Around-the-clock help is required at this stage to reduce the risk of falling and to help the patient with all daily activities.
At stage five, the patient may also experience hallucinations or delusions.
it is worth noting that some Parkinson’s patients never reach stage five, even though the symptoms worsen over time.
Also, the length of time to pass through the different stages varies across individuals. And, not all the symptoms may occur in one individual . For example, one person may have a tremor but balance remains intact.
There are treatments available that can help at every stage of the disease.
The earlier the diagnosis occurs, the more effective the treatment is at alleviating symptoms.
The following video discusses the five stages of Parkinson’s Disease.Video courtesy of The Parkinson’s Foundation
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- 1 The Five Stages Described
- 2 Disease Progression