Parkinson’s Disease – The 5 Stages of Decline

  • Parkinson’s disease mostly affects people over 60, and as with other forms of dementia, there is no cure. There are also no confirmed risk factors, however genetics and exposure to toxins are thought to play a role. 
  • Parkinson’s disease  is defined by a build-up of Lewy body proteins in the brain. These protein deposits cause damage to the nerve cells of the brain, lowering dopamine production and disrupting communication between brain cells. In particular, the parts of the brain controlling movement are mostly affected by the decrease in dopamine levels. 

Parkinson’s disease is not considered a fatal disease. It is degenerative in nature, progressing quickly in some people, and more slowly in others. Moving through all the stages of Parkinson’s disease can take as long as 20 years.

  • Parkinson's disease is progressive in nature, with symptoms worsening over time. Diagnosis is difficult due to the similarity of symptoms with other forms of dementia, namely Alzheimer’s disease. A doctor’s examination and brain scan can reveal any damage to the nerve cells. However Lewy body build-up can only be confirmed during after-death examination.

The 5 Stages of Parkinson's Disease

Movement difficulty normally presents first, with a delay of one year or more before other symptoms start to show. However the symptoms of Parkinson’s disease can vary greatly. In some it may mostly affect muscle control, with not much cognitive loss. Whilst others may have limited decline in motor skills, with other more severe dementia symptoms.

The Five Stages of Parkinson’s Disease were first tabled in 1967 by Hoehn and Yahr. They are still used today as an outline of the disease’s progression in stages. In addition, doctors will use the Unified Parkinson’s Disease Rating Scale (UPDRS) for a more comprehensive diagnosis.

The Hoehn and Yahr stages describe:

Stage 1

Symptoms affect one side of the body.

Stage 2

Symptoms on both sides of the body. Balance unaffected.

Stage 3

Balance affected. Still physically independent.

Stage 4

Unable to walk or stand unassisted.

Stage 5

Wheelchair bound or bedridden.

Stage 1 Parkinson's Disease

Tremors of the hands are often the first signs of Parkinson’s disease. However do not assume a person with hand tremors has Parkinson’s. There are many other causes for tremors, including anxiety, caffeine, medications and seizure.

The symptoms of Parkinson’s disease are usually very mild during this stage, and do not interfere with a person’s daily living. This stage can be so mild, it is often missed entirely. A person may appear clumsier, exhibit some tremors, or changes in posture, movement or facial expressions. Movement restriction or rigidity usually affect one side of the body only.

Stage 2 Parkinson's Disease

During this stage the symptoms remain the same as for stage one, however they become more apparent. Rigidity or movement restriction spreads to both sides of the body. Posture and walking changes become more visible. Muscular degeneration presents as a general slowing down, and may affect speech. A person will still be able to manage with daily activities, however tasks may take longer to complete.

Visible symptoms may include:

  • Posture starts to stoop.
  • General body stiffness, including arms which don’t swing so freely when walking.
  • Legs feel heavy.
  • Handwriting flows less freely, getting smaller.
  • Facial expressions reduced including blinking.
  • Slurring of speech, or fading voice whilst speaking.
  • It may take many months or even years to progress from stage one to stage two.

    A medical diagnosis is usually made during this stage. However if tremors are absent, many mistake the symptoms of stage two to be a part of normal aging.

    Stage 3 Parkinson's Disease

    During this middle-stage, a person is still fully independent. However decreased muscle control will significantly impact daily tasks such as bathing, dressing and eating.

    • There is a general slowing down of all movement, with walking slowing down to a shuffle.
    • Loss of balance resulting in falls becomes more common.
    • Speech becomes softer, or diminishing mid-sentence.
    • Difficulty with swallowing.

    Stage 4 Parkinson's Disease

    In this late stage, a person can no longer live independently. Symptoms can be quite severe and limiting. A walker or other aid may suffice for standing and walking. However most other aspects of daily living will require the assistance of a care-giver.

    Stage 5 Parkinson's Disease

    During this final stage a person will need full time assistance with even basic day to day activities. They will be wheelchair dependent or bedridden.

    Severe stage Parkinson’s disease can include all the typical symptoms of other types of dementia:

    • Inability to carry out basic daily living activities.
    • Inability to control basic bodily functions, resulting in complete incontinence, inability to stand, walk, talk or swallow.
    • Severe or total memory loss.
    • Confusion, hallucinations and delusions.
    • Unresponsive and withdrawn.

    Parkinson’s disease of itself is not fatal, however its symptoms can cause injuries or other health risks, such as choking or pneumonia, which can be fatal.


    * For more detailed medical and scientific analysis, refer to: ​​neurosurgery.harvard-pdstages

    * See also: medscape.com-UPDRS and parkinsonsresource.org-5 stages

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