Stages of Parkinson's Disease

Symptoms vary as the stages of Parkinson's disease progress. Understanding these five Parkinson’s disease stages can help people with cope with the disease.

In Parkinson’s disease (PD), brain cells that make a chemical called dopamine progressively die. Because dopamine is important for sending signals to parts of the brain responsible for movement, a lack of this chemical results in the motor symptoms of Parkinson’s disease — including balance problems, rigidity, and tremors.

There are several non-motor symptoms, too, such as depression and memory problems, which can also impact quality of life, the National Institute of Neurological Disorders and Stroke explains.

Parkinson’s disease symptoms don’t all develop overnight, and not every PD patient has all of the symptoms or the same severity of symptoms. But, despite these variables, Parkinson’s disease is a chronic and progressive movement disorder. Over time, it follows a broad pattern.

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Understanding the stages of Parkinson’s disease

Researchers have identified five specific Parkinson’s disease stages.

• Stage one. Initially, a person with PD typically has only mild symptoms that may be mistaken for musculoskeletal problems at first. Movement symptoms such as tremor occur on only one side of the body and don’t interfere with daily life. Changes in posture, walking, and facial expressions (having an expressionless face with little animation) can occur at this stage.
• Stage two. As symptoms start to worsen, walking problems and a stooped posture are obvious. Movement symptoms, including rigidity, now affect both sides of the body. Although a Parkinson disease patient experiencing this stage of PD can still live alone, daily tasks can be more difficult.
• Stage three. Doctors call this the mid-stage of PD. Movements are slowed considerably, and problems with balance worsen — a condition known as postural instability. Because it often leads to falls, postural instability contributes to disability associated with Parkinson’s disease. A person experiencing stage three of PD can live independently, but simple daily activities like eating and getting dressed can take a great deal of time and effort.
• Stage four. As Parkinson’s disease progresses, symptoms are severe and limit what a patient with PD can do. For example, a patient experiencing stage four PD symptoms may be able to stand but, to move around, needs assistance or a walker. Because of the difficulty performing daily tasks, living alone becomes impossible for people with Parkinson’s disease at this stage.
• Stage five. When Parkinson’s disease symptoms reach this advanced stage, legs may become so stiff that a PD patient cannot stand or walk alone even with a walker and must use a wheelchair or be bedridden. Hallucinations and delusions may also occur. At this stage, nursing care is required for all activities, 24 hours a day, according to the Parkinson’s Foundation.

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