Parkinson's disease is a disease connected with the nervous system that has a bearing on the movement of the body. Many people who have been diagnosed or who have someone in the family with this disease usually wonder how many stages Parkinson's has, how dangerous it is, and what the symptoms at each stage are. Understanding this matter will help patients and families be able to prepare and plan the care and treatment suitably. This article will take you to become acquainted with the 5 stages of Parkinson's disease in detail, together with the suitable approach to care in each period.
Getting to know the division of the stages of Parkinson's disease (Hoehn and Yahr Staging)
The classification of the stages of Parkinson's disease that doctors generally use is the Hoehn and Yahr system, which divides the severity of the disease into 5 stages according to the character of the symptoms and the effect on the living of daily life. This system was developed in the year 1967 and is still used as the standard in assessing the condition of patients to the present day. Knowing which stage the patient is in will help the doctor be able to plan the treatment suitably and more effectively.
Why is assessing the stage of Parkinson's disease important?
Assessing which stage of Parkinson's disease the patient is in is greatly important to planning the treatment. The doctor will use this information in order to adjust the medicine, determine the plan of physiotherapy, and give suitable advice on self-care. Besides this it also helps patients and families understand the state that has arisen and prepare to deal with the changes that may arise in the future. Knowing how the symptoms will proceed will help reduce anxiety and make it possible to plan life better.
The symptoms at each stage of Parkinson's disease
Understanding the symptoms that arise at each stage of the disease will help patients and carers be able to prepare and adapt better. Parkinson's disease has the character of gradually becoming worse and worse as time passes, but the rate of the progression of the disease in each individual may differ. Therefore following up the symptoms closely with an expert physician is an important thing.
Stage 1: the symptoms begin on one side only
The first stage of Parkinson's disease usually begins with mild symptoms that appear on only one side or the other of the body. The symptom met often is slight trembling in the hand, the fingers, or one arm or the other. Some people may feel that one arm or leg does not move as nimbly as before, or there may be slight rigidity. The symptoms at this stage are usually not severe enough to affect the living of daily life. Most patients can still work and do their routines normally. Sometimes the symptoms may not be clear, so that the patient does not give them importance or come for treatment.
Stage 2: the symptoms begin to appear on both sides
When the 2nd stage is entered, the symptoms will begin to extend to the other side of the body, so that both sides of the arms and the legs have symptoms of trembling or of moving more slowly. The rigidity of the muscles may increase, so that movement is not as nimble as it should be. The patient may begin to notice that walking has a slight abnormality, such as shorter steps or dragging the feet. Besides this, the face may begin to show emotion less, which is called a masked face; or speech may begin to have a problem, such as speaking more slowly or the voice becoming quieter. Although the symptoms become clearer, the patient can still keep their balance well and do most activities by themselves.
Stage 3: the middle stage, problems of balance begin
Stage 3 is considered an important turning point of Parkinson's disease, because the patient will begin to have problems concerning balance clearly. Standing and walking will become more difficult, with an increased risk of falling. Movement will become noticeably slower, and it may take longer than normal to do the various routines, such as dressing, eating, or bathing. However, patients at this stage can still help themselves to some degree, and may still be able to do some activities without depending on others very much. The doctor may advise using walking aids, such as a stick or a walker, in order to increase safety.
Stage 4: severe symptoms, help is needed
When the disease proceeds to stage 4, the symptoms will become more severe until they greatly affect the living of daily life. The patient will have great rigidity of the muscles. Movement becomes so slow that they can barely do the various activities by themselves. The patient cannot be alone safely, and must have a carer to help regularly. The balance becomes much worse, so that standing or walking is very difficult or barely possible at all. Some people may still be able to walk a little but must have someone to help or use an assistive device. At this stage the patient needs close care, and the environment in the house may have to be adjusted suitably for safety.
Stage 5: the last stage, having to sit in a wheelchair or be confined to bed
The last stage of Parkinson's disease is the stage at which the symptoms are most severe. The patient will be unable to stand or walk at all by themselves, and must use a wheelchair or lie in bed at all times. Every movement must rely on help from a carer. Besides the problems of movement, patients at this stage may also have other symptoms not connected with movement, such as problems of memory and perception, problems of swallowing, problems of excretion, and problems of mental health. Caring for patients at this stage requires a multidisciplinary team, including doctors, nurses, physiotherapists, and carers who have received training, so that the patient has the best possible quality of life.
Does the progression of the disease differ in each individual?
Although the stages of Parkinson's disease are divided clearly, in reality the progression of the disease in each individual differs greatly. Some people may be in the early stage for many years, while some may proceed to the next stage more quickly. There are many factors that have a bearing on the rate of progression of the disease, such as the age at which the symptoms began, the kind of the main symptoms, the response to medicine, and the overall health of the patient. Therefore following up the symptoms closely with an expert physician is an important thing, so that the plan of treatment can be adjusted to suit the specific needs of each individual patient.
The care and treatment at each stage of Parkinson's disease
Treating Parkinson's disease is directed at relieving the symptoms and slowing the severity of the disease. Although there is still no treatment that can make it heal completely, suitable treatment can greatly help the patient have a better quality of life. The treatment will differ according to the stage of the disease: in the early stage it may emphasise the use of medicine and changing the way of life, while in the more severe stages more intensive treatment may be needed together with support from a multidisciplinary team.
The approach to treatment in order to slow the severity of the disease
The main treatment of Parkinson's disease is the use of medicine in order to increase the level of the substance dopamine in the brain, or to stimulate the dopamine receptors. The medicine generally used is Levodopa, which is usually used together with other medicines in order to increase the effectiveness and reduce the side effects. The use of medicine must be under the care of an expert physician, and the dose may have to be adjusted from time to time as is suitable. Besides the use of medicine, in some cases where the symptoms are severe and cannot be controlled with medicine, the doctor may consider using treatment by surgery, such as Deep Brain Stimulation (DBS), which is the implanting of an electrical stimulation device into the brain in order to help control the symptoms.
Self-care and physiotherapy
Besides treatment with medicine and surgery, self-care and doing physiotherapy are an important part in slowing the severity of the disease and preserving the quality of life. Exercising regularly will help increase the strength of the muscles, improve balance, and reduce the rigidity. The activities recommended are, for example, walking, swimming, tai chi, or yoga. Doing physiotherapy with an expert physiotherapist will help design a programme of exercise suited to the ability and the needs of each individual patient.
At PYONG Rehabilitation Clinic we have a physiotherapy service designed specifically for patients with Parkinson's disease and diseases concerning the nervous system. The specialist physicians in the field of rehabilitation medicine will assess the symptoms and design a plan of treatment suited to each patient.
We have advanced neurorehabilitation technology that helps restore the working of the brain and the nervous system, which includes:
- Stimulating the brain with magnetic waves (Transcranial Magnetic Stimulation - TMS) in order to help improve the working of the brain and reduce the symptoms connected with the nervous system
- Stimulation with peripheral electromagnetic waves (Peripheral Magnetic Stimulation - PMS), which helps restore the working of the muscles and the nerves, increase the strength of muscles that are weak, and reduce the rigidity
- Training walking with the walking-assistance robot (Robotic Exoskeleton Gait Training), which lets patients who have a problem of walking train walking safely and effectively, with the level of difficulty adjustable according to the ability of the patient
- Training the hand and coordination with a robot (Robotic Hand Neurorehabilitation), which helps restore the use of the hand and the fingers that are weak or move with difficulty
- Occupational Therapy in order to train the skills of living daily life and doing the various activities, so that one can care for oneself more
- Physiotherapy by expert physiotherapists who will design a programme of exercise specific to the individual, in order to increase strength, flexibility, and balance
Our team of doctors and nutritionists also gives advice on nutrition suitable for patients with Parkinson's disease, because eating correctly will help increase the effectiveness of the medicine and keep health better overall. For patients who need intensive rehabilitation, we have PYONG Rehabilitation Penthouse, which gives a complete care service in an environment designed specifically for rehabilitation, with a multidisciplinary team caring for them throughout the 24 hours, together with the most modern and complete treatment technology.
Frequently asked questions (FAQ)
How long does each stage of Parkinson's disease take?
There is no certain answer to this question, because the progression of the disease in each individual differs greatly. Some people may take many years in each stage, while some may proceed more quickly. On average, the length of time from the diagnosis until the most severe stage may take from several years to several decades. Suitable care and treatment and changing the way of life can help slow the progression of the disease.
How is the stage of the disease diagnosed?
The doctor will assess the stage of the disease by examining the body, asking about the symptoms, and looking at the effect on the living of daily life. The assessment will consider many factors, such as the severity of the trembling, the rigidity of the muscles, the slowness of movement, and the ability to keep balance. Besides this the doctor may use a standard assessment form, such as the Unified Parkinson's Disease Rating Scale (UPDRS), in order to help in assessing in more detail.
In summary
Understanding how many stages Parkinson's disease has and what the symptoms at each stage are will help patients and families be able to prepare and plan the care suitably. Parkinson's disease is divided into 5 stages according to the Hoehn and Yahr system, beginning from mild symptoms appearing on only one side in stage 1, through to severe symptoms that make the patient have to sit in a wheelchair or be confined to bed in stage 5.
Although there is still no treatment that can make it heal completely, treatment with medicine, doing physiotherapy, and suitable self-care can help slow the severity of the disease and keep the quality of life good. If you or someone you love has symptoms that give cause for suspicion, an expert physician in the nervous system or a physician specialising in neurological internal medicine (a neurologist) should be consulted in order to receive suitable diagnosis and treatment.
If you want advice about restoring the condition and caring for the symptoms of diseases concerning the nervous system, you may contact PYONG Rehabilitation Clinic, which has a team of physicians specialising in the field of rehabilitation medicine and can coordinate with physicians specialising in neurological internal medicine (brain doctors) for complete multidisciplinary care and treatment.