Stages of Parkinson's
Theory of Parkinson's Disease
Parkinson's Disease impacts people in different ways. Not everyone will experience all the symptoms of Parkinson's, and if they
do, they won't necessarily experience them in quite the same order or at the same intensity. There are typical patterns of
progression in Parkinson's Disease that are defined in stages.
During this initial stage, the person has mild symptoms that generally do not interfere with daily activities. Tremor and other movement
symptoms occur on one side of the body only. Changes in posture, walking and facial expressions occur.
Symptoms start getting worse. Tremor, rigidity and other movement symptoms affect both sides of the body. Walking problems and poor
posture may be apparent. The person is still able to live alone, but daily tasks are more difficult and lengthy.
Considered mid-statge, loss of balance and slowness of movements are hallmarks. Falls are more common. The person is still fully
independent, but symptoms significantly impair activities such as dressing and eating.
At this point, symptoms are severe and limiting. It's possible to stand without assistance, but movement may require a walker.
The person needs help with activities of daily living and is unable to live alone.
This is the most advanced and debilitating stage. Stiffness in the legs may make it impossible to stand or walk. The person requires a wheelchair
or is bedridden. Around-the-clock nursing care is required for all activities. The person may experience hallucinations and delusions.
The Parkinson's community acknowledges that there are many important non-motor symptoms as well as motor symptoms.
Your doctor may refer to a scale to help them understand the progression of the disease. The stages of Parkinson's corresponds both to the
severity of movement symptoms and to how much the disease affects a person's day to day life. The most commonly used rating scales focus on
motor symptoms. They are the:
» Hoehn and Yahr Stages follow a simple rating scale, first introduced
in 1967. Clinicians use it to describe how motor symptoms progress in Parkinson's Disease.
» The Unified Parkinson's Disease Rating Scale (UPDRS) is
a more comprehensivetool used to account for non-motor symptoms, including mental functioning, mood and social interaction.
- Accounts for cognitive difficulties, ability to carry out daily activities and treatment complications
New scales include information on non-motor symptoms. While these 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 may find the disease progresses more quickly.
Theory of Parkinson's Disease Progression: Braak's Hypothesis
The current theory (part of the so-called Braak's hypothesis) is that the earliest signs of Parkinson's are found
in the enteric nervous system, the medulla and the olfactory bulb, which controls sense of smell. Under this theory, Parkinson's
only progresses to the substandtia nigra and cortex over time.
This theory is increasingly borne out by evidence that non-motor symptoms, such as a loss of sense of smell, sleep disorders
and constipation may precede the motor features of the disease by several years. For this reason, researchers are increasingly focused on
these non-motor symptoms to detect Parkinson's Disease as early as possible and to look for ways to stop its progression.
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