5 Stages of Parkinson's

Written by Kristeen Cherney | Published on August 28, 2013
Medically Reviewed by George T. Krucik, MD, MBA on August 28, 2013

5 Stages of Parkinson’s

Parkinson’s disease (Parkinsonism) is marked by the presence of certain recognizable symptoms. These include uncontrollable shaking or tremor, lack of coordination, and speaking difficulties. However, signs vary and symptoms may worsen as the disease progresses.

Many doctors who diagnose this brain disorder rely on the Hoehn and Yahr rating scale to classify the severity of symptoms. The scale is broken into five stages based on disease progression. The main symptoms include:

  • uncontrollable trembling and tremors
  • slowed movement (bradykinesia)
  • balance difficulties, and eventual problems standing up
  • stiffness in limbs

Stage I

Stage I is the mildest form of Parkinson’s. At this level, there may be unusual symptoms, but they’re not severe enough to interfere with daily tasks and overall lifestyle. In fact, the signs of the disorder are so minimal at this stage that they’re often missed.

Tremors and other difficulties in movement are generally exclusive to one side of the body during stage I. Prescribed medications can work effectively to minimize symptoms at this stage.

Stage II

Stage II is considered a moderate form of Parkinson’s, and the symptoms are much more noticeable than those experienced in stage I. Stiffness, tremors, and trembling may be more noticeable, and changes in facial expressions can occur. While muscle stiffness prolongs task completion, stage II does not impair balance.

Patients at this stage feel symptoms on both sides of the body and sometimes experience speech difficulties. The progression from stage I to stage II can take months or even years. There is no way to predict individual progression.

Stage III

Stage III is the mid-stage in Parkinson’s, and it marks a major turning point in the progression of the disease. Many of the symptoms are the same as those in stage II, except now loss of balance and decreased reflexes can also occur. This is why falls are common in stage III.

Parkinson’s significantly affects daily tasks at this stage, but patients are still able to complete them. Medication combined with occupational therapy may help decrease symptoms.

Stage IV

Independence separates Parkinson’s patients from stage III and stage IV. During stage IV, it’s possible to stand without assistance. However, movement may require a walker or other type of assistive device.

Many patients are unable to live alone at this stage of Parkinson’s because of significant decreases in movement and reaction times. Living alone at stage IV or later may make many daily tasks impossible, and can be extremely dangerous.

Stage V

Stage V is the most advanced and debilitating stage of Parkinson’s disease. Advanced stiffness in the legs can also cause freezing upon standing. Patients require wheelchairs, and are often unable to stand without falling. Around-the-clock assistance is required to prevent falls.

Patients at this stage may even experience hallucinations and fall victim to occasional delusions. Side effects from medications at stage V can outweigh the benefits.

Alternative Rating System

One complaint about the Hoehn and Yahr rating system is that it focuses solely on symptoms of movement when there are other types of health signs associated with Parkinson’s disease. This is why some doctors may also use the Unified Parkinson’s Disease Rating Scale. It allows them to rate cognitive difficulties that may impair day-to-day tasks and the efficacy of treatment.

What You Can Do

As of 2013, there is no cure for Parkinson’s disease. Understanding the symptoms of the condition can prompt early detection to improve quality of life. The National Institute on Aging says evidence suggests that Parkinson’s may be genetic, and that men are at higher risk for developing the disease.

Knowing your own individual risk factors can help you detect symptoms in the earliest stages. Keep in mind that not all patients progress into the most severe stages of Parkinson’s, and that it’s not considered fatal.

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