Parkinson’s disease is far more than a medical diagnosis. Filled with twists and turns, moments of frustration, and remarkable moments of triumph, it affects millions of lives worldwide, including our loved ones who stand beside us in this journey. As a patient and as a caregiver, it is important to understand the condition in detail, and this includes its causes, symptoms, as well as progression. Through this blog, we’ll throw light on the 5 stages of Parkinson’s, what we can expect at each stage, and the ways in which we can manage the disease.
Management and treatment of Parkinson’s disease can differ from patient to patient. However, the main aim is to alleviate symptoms and improve quality of life. Medication, physiotherapy, occupational therapy, and lifestyle modifications play a vital role in managing the condition.
At Plexus, we offer advanced Cell therapy as part of our Regenerative Rehabilitation for Parkinson’s. Our team of expert neurologists and Cell specialists, headed by Dr Na’eem Sadiq, will devise a personalised rehabilitation plan tailored to your specific needs and stage of the disease.
What Is Parkinson’s Disease?
Parkinson’s disease is one of the most common neurodegenerative conditions in the world. It impairs muscle control, balance, and movement. It results in the deterioration of the cells in substantia nigra (in the basal ganglia). It inhibits the brain’s ability to produce dopamine, the happy hormone. As the disease progresses, the neurons in the brain completely deteriorate. This leads to severe motor impairment, tremor, stiffness, slowed or delayed movement, dysphagia, sleep issues, fatigue, difficulty in speech, etc.
Its symptoms set in gradually, sometimes with a barely noticeable tremor in just one hand. Tremors are a common symptom of Parkinson’s, but as the disorder advances, the patient may also experience stiffness and slowing of movement.
Understanding the 5 Stages of Parkinson’s Disease
Though Parkinson’s is progressive and worsens over time, it affects people differently. Not all people with Parkinson’s will experience all the symptoms. Symptoms may vary in severity between patients. The stages of Parkinson’s are often described using the Hoehn and Yahr scale or the Unified Parkinson’s Disease Rating Scale (UPDRS). Let’s look at this in detail.
Stage 1 Parkinson’s Disease – Early Stage
- Symptoms are mild and typically go unnoticed by most people.
- Tremors or other motor symptoms may be present on one side of the body (unilateral involvement).
- Daily activities are not significantly impacted.
- Diagnosis at this stage may be difficult.
Stage 2 Parkinson’s Disease – Mild Stage
- Symptoms become more noticeable, and can affect the midline without impairing balance
- Tremors, rigidity, and bradykinesia (slowness of movement) may affect both sides of the body (bilateral involvement).
- Patient may lose facial expressions on both sides of the face
- Soft and monotone voice, slurred speech, and fading volume may appear.
- Balance and posture issues may start to appear.
- Daily activities are still manageable, but performance may have become slower.
But it should be noted that if stage one was missed and the only symptoms of stage two are slowness or lack of spontaneity of limbs, Parkinson’s may be misinterpreted as only advancing age.
Stage 3 Parkinson’s Disease – Moderate Stage
- Symptoms become more pronounced and interfere with daily life.
- Balance and coordination problems worsen, making falls more common.
- Independence in daily activities may be compromised.
- Medication adjustments may be necessary.
- Diagnosis can be confirmed at this stage.
- Daily activities are still manageable, but performance may have become slower.
The doctor may examine impairments in reflexes at this stage by standing behind the patient and gently pulling the shoulders to know if the patient has trouble maintaining balance and falls backward (the doctor of course will not let the patient fall).
Stage 4 Parkinson’s Disease – Advanced Stage
- Severe symptoms significantly limit a person’s ability to function independently.
- Rigidity and bradykinesia are prominent.
- Walking may be possible but is difficult without assistance.
- Daily activities require substantial help from caregivers.
- Disease has progressed to a severely disabling disease.
By this stage, many patients seek the assistance of a walker to move around.
Stage 5 Parkinson’s Disease – End Stage
This is the most advanced stage of Parkinson’s.
- Patients are prone to falls while standing or turning.
- Individuals are often wheelchair-bound or bedridden.
- Communication is severely impaired, and there may be cognitive changes.
- There is a high dependence on caregivers for all aspects of daily living.
- Round-the-clock care is needed at this stage.
Hallucinations and delusions may also happen at this stage.
It is important to note here that many patients do not reach the end stage of Parkinson’s. The disease progresses in patients differently, and in most cases the patients are at stage 3 or stage 4.
As is the case with all neurodegenerative conditions, the earlier the diagnosis, and the earlier the stage at which Parkinson’s is diagnosed, the more effective the treatment is at alleviating symptoms.
Tailored Parkinson’s Rehabilitation at Every Stage
Stage 1–2 (Early/Mild) – Gentle physical therapy, voice modulation, posture training, and lifestyle guidance to maintain independence and slow progression.
Stage 3 (Moderate) – Balance and gait training, occupational therapy for daily tasks, targeted speech therapy, and adaptive strategies to reduce fall risk and maintain mobility.
Stage 4 (Advanced) – Supportive physiotherapy to preserve flexibility, home environment modifications, and caregiver education to ease daily living.
Stage 5 (Severe) – Focused palliative rehabilitation, safe mobility support (bed-to-chair transfers), respiratory exercises, and comprehensive caregiver guidance for comfort and quality of life.
Plexus Rehabilitation for Parkinson’s
Our Parkinson’s rehabilitation programme comprises –
- Cell therapy
- Occupational therapy
- Physical therapy
- Speech and language therapy
- Cognitive rehabilitation therapy
- Bradykinesia management
- Rigidity management
- Agility training
- Functional training
- Hand function training and more
FAQs
1. How quickly does Parkinson’s progress through the stages?
Parkinson’s progresses differently for each person. While some experience changes over many years, others may notice faster shifts. On average, it can take over 20 years to move through the stages, but early diagnosis, treatment, and lifestyle changes can help slow progression.
2. At what stage do Parkinson’s patients sleep a lot?
Increased daytime sleepiness often appears in the later stages (Stage 4 or 5), but it can also happen earlier due to medications, changes in brain chemistry, or poor nighttime sleep. A doctor can help identify the cause and recommend ways to improve rest.
3. Are symptoms worse in the later stages of Parkinson’s?
Yes. In advanced stages, symptoms like stiffness, slowness, balance problems, and difficulty speaking or swallowing tend to become more pronounced. However, tailored rehabilitation and supportive care can improve comfort and daily function even in later stages.
4. Do all Parkinson’s patients reach stage 5?
Not necessarily. Some people remain in earlier stages for many years, especially with good medical care and healthy habits. Stage 5 is the most advanced and is not experienced by every patient.
5. How long does it take to go from stage 1 to stage 4 Parkinson’s?
The timeline varies greatly from person to person. Factors include age at diagnosis, overall health, genetics, and access to treatment and rehabilitation.
About the Author
Dr. Na’eem Sadiq
Medical Director of Plexus
Dr. Na’eem Sadiq is a globally recognized neurologist and neuropsychiatrist, renowned for his contributions to the treatment of complex neurological disorders. He founded Plexus in 2011 with a mission to enhance the quality of life for patients living with neurological conditions.
With over 35 years of clinical experience, Dr. Sadiq is considered a leading expert in the field. His internationally acclaimed research spans key topics such as Demyelinating Polyneuropathy, Multiple Sclerosis, Epilepsy, and Migraine, positioning him at the forefront of neurological care worldwide.
