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).