Parkinson’s disease is a neurological movement disorder that usually worsens over time. There are several ways to measure the progression of Parkinson’s disease (PD). One example is the five stages.

Although grouping symptoms into stages can be helpful, no two people with Parkinson’s are exactly alike. Everyone experiences their own unique symptoms and disease progression. Some develop advanced Parkinson’s disease after many years. Others experience a rapid disease progression. Here are the five stages of Parkinson’s progression and what they mean.

What Are the 5 Stages of Parkinson’s Disease?

The Parkinson’s staging system is based on the Hoehn and Yahr scale from 1967. The Hoehn and Yahr system focuses on disability caused by motor (movement) symptoms. Examples include bradykinesia (slowness of movement), tremors or shaking, and balance problems. Neurologists use the scale to track symptoms and disease progression.

A higher stage number means more advanced disease. People with a higher stage of Parkinson’s experience more disability symptoms and trouble with daily activities than those in the lower stages.

Stage 1

During this early stage of Parkinson’s disease, people show mild symptoms that usually do not get in the way of their daily routines. Tremor, stiffness, and bradykinesia happen on only one side of the body.

In addition, a person with stage 1 Parkinson’s may also have movement symptoms such as:

• Difficulty with balance
• Trouble moving their legs and arms while walking
• Decreased facial expression

Stage 2

Parkinson’s symptoms begin to worsen during stage 2, spreading from one side of the body to both sides. There may be difficulty walking and changes in posture, facial expression, and voice.

Individuals with stage 2 Parkinson’s can typically still live by themselves. However, daily tasks may become more difficult and time-consuming.

Stage 3

Loss of balance and bradykinesia are the most common symptoms of this stage of Parkinson’s. Individuals at stage 3 are likely to need help with balance to avoid falls.

People who are at stage 3 Parkinson’s can typically still carry out their daily activities without help. But they may start to have a harder time with tasks like feeding and dressing themselves.

Stage 4

This stage marks the beginning of advanced-stage Parkinson’s disease. At this point, Parkinson’s symptoms have become limiting and severe. By stage 4, many people need a walker to get around.

In addition, those in stage 4 typically need help with the activities of daily living. As a result, they may need a caregiver to help them manage chores and other tasks.

Stage 5

This is the most severe stage of neurological (brain) dysfunction in Parkinson’s disease. Rigidity or stiffness can impair the ability to stand and walk. Those in stage 5 may be bedridden or require a wheelchair.

Constant nursing care is required for all daily activities. Nonmotor symptoms, like delusions and hallucinations, are also possible.

Other Parkinson’s Tracking Tools

Some neurologists also use the Unified Parkinson’s Disease Rating Scale (UPDRS) to track symptoms. The UPDRS looks at several factors, including nonmotor experiences in daily life. The UPDRS focuses more on the experience of people with Parkinson’s rather than just their ability to complete certain tasks.

Members of MyParkinsonsTeam have discussed a wide range of experiences with Parkinson’s progression. “I was diagnosed with PD in 2003, and my symptoms did not advance significantly until 2019,” one member wrote. Another said, “My PD has advanced slowly, and I feel pretty good most of the time.”

Learning about the stages of Parkinson’s disease can help you plan, prepare, and make decisions.

Navigating Advanced Parkinson’s Disease

Apart from neurological dysfunction, people with advanced-stage Parkinson’s may develop other problems.

When Medication Stops Working

People with advanced Parkinson’s disease have likely been taking their medications for a long time. This means they are at risk for experiencing a wearing-off effect of their medication.

Parkinson’s research shows that this may happen for the following reasons:

• Loss of brain cells — The brain has fewer cells that make dopamine (the neurotransmitter involved in Parkinson’s disease) and can’t store as much of the drug as before. This causes meds to wear off faster.
• Delayed gastric emptying — This symptom of Parkinson’s means digestion is slower, so the body doesn’t absorb medication as quickly.

When someone with advanced Parkinson’s disease no longer responds well to medications taken by mouth, their health care provider may recommend injectable or infused medications to manage their symptoms.

Dealing With Dyskinesia

Long-term use of the drug levodopa — used to treat Parkinson’s motor symptoms — may lead to a movement disorder called dyskinesia.

This uncontrolled movement disorder can:

• Involve just one part of the body or the entire body
• Cause swaying, writhing, or fidgeting
• Happen even when tremor, stiffness, and slowness are controlled
• Appear when someone is excited or emotionally stressed
• Be painful and impair activities of daily living

There are several treatments for dyskinesia in advanced Parkinson’s disease. Options may include:

• Altering the dose or timing of levodopa — This can help provide an effective dose without as many side effects.
• Changing to a different medication — If levodopa is causing dyskinesia, your doctor might recommend switching to a different formulation or changing your medication completely.
• Adding apomorphine (Apokyn) — This injectable or infused medication can help you manage symptoms during levodopa’s “off” periods.
• Adding amantadine (Gocovri) — This drug works on a different pathway to help decrease dyskinesia.

Talk With Others Who Understand

MyParkinsonsTeam is the social network for people with Parkinson’s disease and their loved ones. On MyParkinsonsTeam, more than 101,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s disease.

How has your Parkinson’s progressed? Do you know what stage you’re at? Share your experience in the comments below, or start a conversation by posting on your Activities page.