Parkinson’s disease is a neurodegenerative disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination. Tremors are a common sign of Parkinson’s, but can easily progress to uncontrollable shaking, lack of coordination, and speaking difficulties. Symptoms are known to set in gradually, sometimes with slight tremors in just one hand, and may worsen as the disease progresses.

Like most neurological conditions, not all people with Parkinson’s will experience all the symptoms or with the same severity, or speed. Physicians have established certain stages of Parkinson’s Disease, known as the Hoehn and Yahr Scale, that elucidate how the disease progresses. These stages are used by physicians all over the world to classify patients.

What is Parkinson’s disease?

Parkinson’s Disease (PD) is a brain condition that primarily impairs the dopamine-producing neurons in an area of the brain called substantia nigra, causing unintended or uncontrolled movements. Dopamine plays an integral role in regulating body movements, so a reduction in its levels could be the cause for many of the symptoms. One of the most common motoric neurodegenerative diseases, Parkinson’s Disease is also known as the “Shaking Palsy”. It is generally diagnosed based on one’s symptoms, medical history, and a detailed physical examination. Let’s get a better understanding of Parkinson’s Disease symptoms and Parkinson’s Disease treatments.

Early stages of Parkinson’s Disease

The stages of Parkinson’s Disease can be broken down into five phases, based on the observed symptoms. Parkinson’s Disease treatments also vary according to the signs of Parkinson’s Disease.

  • Stage one of Parkinson’s Disease

    In this stage, the symptoms of the disease appear in a milder form and are only seen on one side of the body. It is called unilateral involvement, wherein the functional impairment may be minimal or nil. As the signs of Parkinson’s Disease are mild, the person affected may not seek medical attention and physicians may be unable to reach a very clear diagnosis. Symptoms at this stage may include tremors, such as intermittent tremor of one hand, one leg may feel clumsy compared to the other or one side of the face may feel distorted, impacting the expression. It is usually very difficult to arrive at a diagnosis at this stage and the physician may wait to see if the symptoms worsen over time before coming to a formal diagnosis.

  • Stage two of Parkinson’s Disease

    This stage is considered pretty early in the stages of Parkinson’s Disease, and is characterized on both sides of the body. This is called bilateral involvement. Symptoms can affect the midline without impairment to balance. It may take months or years for symptoms to progress from stage one to two. The symptoms of Parkinson’s Disease in this stage may include loss of facial expression on both sides of the body, soft voice, monotone voice, fading volume after speaking loudly, slurring speech, stiffness, or rigidity of the muscles in the trunk that may result in neck or back pain, stooped posture, and general slowness in all daily activities. However, the patient may still be able to perform all their daily activities independently. The doctor can arrive at a diagnosis easily if the patient has tremors. 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, then Parkinson’s may be misinterpreted as simply advancing age.

  • Stage three of Parkinson’s Disease

    In this stage of Parkinson’s, the prominent symptoms are loss of balance and slowness of movement. Balance is compromised significantly by not being able to make the rapid, automatic, and involuntary adjustments necessary to prevent falls. The affected person may fall frequently in this stage. All other symptoms of Parkinson’s may be evident and a general diagnosis can be made with conviction at this stage. In many cases, the doctor will examine the impairments in reflexes 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). An important aspect of stage three is the patient can still independently do their daily living activities, such as dressing, maintaining hygiene, and eating.

  • Stage four of Parkinson’s Disease

    In this stage, Parkinson’s has progressed to a severely disabling disease. The patient with stage four may still be able to walk and stand unassisted, but they are visibly incapacitated. Many of them seek the assistance of a walker to move around. Independent living is almost impossible in this stage and needs assistance with some activities of daily living. The necessity for help to live is the important feature of this stage.

Final stage of Parkinson’s Disease

The fifth stage is the most advanced stage among all the signs of Parkinson’s Disease, and is characterized by an inability to rise from a chair or get out of bed without assistance. Patients are prone to fall while standing or turning. They may even freeze or stumble when walking. Round-the-clock care is needed at this stage to prevent falls and help the patient do daily activities. Hallucinations and delusions might also happen in this stage.

The time taken for PD to progress from one stage to another, varies from individual to individual. Moreover, not all symptoms of Parkinson’s Disease may be evident in one individual. For example, one person may have hand tremors, but may still be able to maintain balance. Quality treatments are available to handhold the patient through every stage of the disease. The earlier the diagnosis, and the stage at which the disease is diagnosed, the more effective the Parkinson’s Disease treatment is at alleviating Parkinson’s Disease symptoms.

What to expect at the end stage of Parkinson’s Disease?

Among the five stages of Parkinson’s Disease, in the end-stage, the patients experience non-motor symptoms. These can include incontinence, insomnia, and dementia, thereby making the Parkinson’s Disease treatment tricky. Some medications used to treat Parkinson’s Disease are also known to cause hallucinations, although this is seen more frequently if the patient also has dementia.

What happens in late stages of Parkinson’s Disease?

When patients reach the later stages of Parkinson’s Disease, they tend to have severe posture issues in their back, neck, and hips. Parkinson’s Disease treatments are likely to involve a wheelchair, since patients are often unable to stand on their own without falling and some of them might also be bedridden. In the end-stage, patients tend to experience non-motor symptoms. Furthermore, advanced stiffness in the legs can also freeze upon standing, making it impossible to stand or walk.

While there is no one specific test to conclusively diagnose Parkinson’s disease, a neurologist or physician trained in nervous system conditions, will diagnose Parkinson’s disease based on your medical history, a review of your overall signs and symptoms, followed by a neurological and physical examination. If you’re looking for a good Stem Cell Research centre in Bangalore for neurorehabilitation, you should definitely visit Dr Na’eem Sadiq.

Dr Na'eem Sadiq is a respected stem cell specialist at Plexus, and a prominent neurologist in Bangalore. He studied neurology and clinical neurophysiology in London, and worked with some of the most prestigious medical institutions in England, and the Middle East. He completed his MBBS at Bellary Government Medical College, and a postgraduate degree in psychiatry from NIMHANS in Bangalore.

Dr Na'eem has perfected his knowledge and expertise in Continuing medical education (CME), and training in tissue culture, Stem Cell Therapy, and neurology. Dr Na'eem Sadiq possesses an undying passion to improve people’s lives. This led to the creation of Plexus, a neuro and Stem Cell Research centre in Bangalore in neurosurgery, and neurorehabilitation.