Understanding the Symptoms and Stages of Parkinson’s Disease

Parkinson's occurs when a group of cells in an area of the brain that provide a chemical called dopamine begin to malfunction and eventually die. Dopamine is an essential neurotransmitter that transports signals to the brain that control movement initiation and coordination.

When Parkinson's occurs, these cells die at a faster rate and the amount of dopamine produced in the brain decreases.

Some of the most common symptoms of Parkinson's Disease include:

• Tremors in hands, arms, legs, jaw, and face
• Dementia
• Slowness of movement
• Rigidity, or stiffness of the limbs and trunk
• Sleep disturbances
• Constipation
• Postural instability or impaired balance and coordination

Additional symptoms may also include:

• Skin problems
• Depression
• Changes in speech
• Fear/anxiety
• Loss of facial expression
• Memory difficulties/slowed thinking
• Difficulty swallowing
• Urinary problems
• Aches and pains
• Fatigue/Loss of energy
• Small, cramped handwriting

According to the Parkinson’s Foundation, “Parkinson’s disease (PD) impacts people in different ways. Not everyone will experience all the symptoms of PD; even if people do, they won’t necessarily experience the symptoms in quite the same order or at the same intensity. While symptoms and disease progression are unique to each person, knowing the typical stages of Parkinson’s can help you cope with changes as they occur. Some people experience the changes over 20 years or more. Others find the disease progresses more quickly.”

There are 5 primary stages of PD as described by Hoehn & Yahr in 1967, based on levels of clinical disability. However, there may be as many as 8 stages of PD, say recent findings of the Movement Task Force.

• Stage 1 – During this initial stage, the person has mild symptoms that generally do not interfere with daily activities. Tremor or other movement symptoms occur on one side of the body only. Changes in posture, walking, and facial expressions occur.
• Stage 2 – Symptoms start getting worse. Tremor, rigidity, and other movement symptoms affect both sides of the body or the midline (neck and trunk). Walking problems and poor posture may be apparent. The person is able to live alone, but daily tasks are more difficult and lengthier.
• Stage 3 – Considered mid-stage, loss of balance (such as unsteadiness as the person turns or when he/she is pushed from standing) is the hallmark. Falls are more common. Motor symptoms continue to worsen. Functionally, the person is somewhat restricted in his/her daily activities but is still physically capable of leading an independent life. Disability is mild to moderate at this stage.
• Stage 4 – At this point, symptoms are fully developed and severely disabling. The person is still able to walk and stand without assistance but may need to ambulate with a cane or walker for safety. The person needs significant help with activities of daily living and is unable to live alone.
• Stage 5 – This is the most advanced and debilitating stage. Stiffness in the legs may make it impossible to stand or walk. The person is bedridden or confined to a wheelchair unless aided. Around-the-clock care is required for all activities.

Three additional stages (phases) identified by the Movement Task Force that lead up to Stage 1 are:

• Preclinical Phase – The degeneration of the dopamine-producing neurons has already begun, but no clinical symptoms are evident yet.
• Prodromal Phase – Some symptoms are present, but they are insufficient for the clinician to make a diagnosis of PD.
• Clinical Phase – Parkinsonian symptoms have manifested and are clearly recognizable.

There are multiple ways a professional caregiver can help during the stages of PD:

• Caregivers offer emotional support, physical help, and understanding.
• Caregivers communicate with family and healthcare providers to discuss symptoms, observations, or concerns.
• Caregivers set realistic goals with their clients based on what they can and can’t do.
• Caregivers are patient and understanding and allow time and space for the client to be able to accomplish tasks on their own.
• Caregivers encourage the client to exercise and engage in simple activities they enjoy.
• Caregivers are honest with themselves, the Parkinson’s patient, and his/her family.
• Caregivers modify areas to promote safety (ex: maintain clear paths throughout the home).