The Stages of Parkinson's Disease

Parkinson's disease is a devastating and complex disease that interferes with movement more and more as time goes on. It also produces a wide range of other problems for patients. Symptoms of the disease vary somewhat, but they may include problems with swallowing and chewing, speech impairments, urinary problems or constipation, excessive sweating and other skin problems, depression and other emotional changes, and difficulties with sleep.

No one can predict which of these symptoms will affect a particular patient, and the intensity of the symptoms varies from person to person. None of these secondary symptoms is fatal, although swallowing problems can cause choking.

The progression of symptoms in PD may take 20 years or more. In some people, however, the disease progresses much more quickly. Below is one commonly used system for describing how the symptoms of PD progress.

Hoehn and Yahr Staging of Parkinson's Disease

Stage One

  • Signs and symptoms on one side only 
  • Symptoms mild 
  • Symptoms inconvenient but not disabling 
  • Usually presents with tremor of one limb 
  • Friends have noticed changes in posture, locomotion and facial expression

Stage Two

  • Symptoms are bilateral 
  • Minimal disability 
  • Posture and gait affected

Stage Three

  • Significant slowing of body movements 
  • Early impairment of equilibrium on walking or standing 
  • Generalized dysfunction that is moderately severe

Stage Four

  • Severe symptoms 
  • Can still walk to a limited extent 
  • Rigidity and bradykinesia 
  • No longer able to live alone 
  • Tremor may be less than earlier stages

Stage Five

  • Cachectic stage 
  • Invalidism complete
  • Cannot stand or walk 
  • Requires constant nursing care

Another commonly used scale is the Unified Parkinson's Disease Rating Scale (UPDRS). This much more complicated scale has multiple ratings that measure mental functioning, behavior, and mood; activities of daily living; and motor function. Both the Hoehn and Yahr scale and the UPDRS are used to measure how individuals are faring and how much treatments are helping them.


The National Institute of Neurological Disorders and Stroke (NINDS) conducts and supports research on brain and nervous system disorders. NINDS is one of the more than two dozen research institutes and centers that comprise the National Institutes of Health (NIH).

Comments (1 to 6 of 6)

lp532008

Apr 10, 2008
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My client doesn't have tremors, but suffers with the rigidity. She's tried various meds for that and not any help. She's worse in the evenings, and even moans. is this normal and is there something else to try?

worried

Jun 16, 2008
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I just found out that my dad has pd...The one thing that worries me is that at night when he's sleeping he has begun to hit my mother...is this because of PD????...He feels so guilty because he doesn't even know he's doing it..My mom can usually tell when and can get him to stop, but what if one of these days he doesn't? Is there something that can be done...They are talking about separate beds, and they hate that idea, they have been together for over 50 years and have never slept apart.

jacd

Jun 22, 2008
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My mother has tremors but not pd, or they say she doesn't. Can her nonsequencial tremors be a sign that pd will occur? What exactly are nonsquencial tremors anyway?

kitten53

Jun 24, 2008
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my mom has had pd for 6 yrs. she is 80 and take carb/levo 4 times aday.. She is hallucinating very badly.

shavon

Jul 17, 2008
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my father was dignosed with pd 15 years ago. it seems to me since i can remember that the medications havent worked that well for him. i understand that this is a progressive condition, but it seems as if it has been progressing at an alarming speed. he also has trouble with high/low blood pressure, he has what we call episodes when he blacks out. is this normal with people who have pd?

drinkwater

Jul 17, 2008
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my mom has most of the symptoms that are described. the most severe being rigidity/bradykinesia, difficulty swallowing, constipation, and sometime difficult speaking. (THE DIAGNOSE HAS NOT BEEN MADE yet) BASED ON HER SYMPTOMS I AM PRETTY MUCH SURE THAT IS WHAT SHE HAS..sHE IS 01 YRS OLD AND IS PRESENTLY IN THE HOSPITAL WITH TWO RIGHT SIDE FRACTURED RIBS. Any answer or advice on how to go forward will be appreciated, especially if anyone is on some drug that is treating those symptoms effectively.
thank you

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