Parkinson’s disease (PD) is a movement disorder of the nervous system that deteriorate over time. While nerve cells (neurons) in parts of the brain wane or are damaged or die, people may notice problems with movement, tremor, stiffness in the limbs or the trunk of the body, or impaired balance. As these symptoms become more apparent, people may have difficulty walking, talking, or completing other simple tasks. Not everyone with one or more of these symptoms has PD, as the symptoms appear in other diseases as well. No cure for PD exists today, but research is ongoing, and medications or surgery can often provide substantial improvement with motor symptoms.
(National Institute of Neurological Disorders and Stroke [NINDS], National Institutes of Health [NIH])
The symptoms of Parkinson’s disease
The four primary symptoms of PD are:
- Postural instability
The most common symptoms of Parkinson’s disease are stiffness in different parts of the body, shaking (particularly in the hands, legs, and face), difficulty with balance and coordination, difficulty walking and slow movements. As the disease advances, muscle pain and cramps, problems with sleep, memory impairment, depression, and behavioural changes may set in, too. The Hoehn and Yahr scale is used to stage Parkinson’s disease according to the order in which symptoms appear and gradually worsen. There were previously five stages in the Hoehn and Yahr scale, but over time it was modified as stages 1.5 and 2.5 were added to it.
This is the earliest stage of Parkinson’s disease. At this stage, the symptoms a person experience are very mild and do not cause any disability or interference with day-to-day living. The symptoms also affect only one side of the body—an occurrence known as unilateral involvement. The most common symptoms at this stage are tremors (usually in one hand or leg), and slight changes in posture, movement, and facial expressions. Due to how mild the symptoms are, it is usually exceedingly difficult for a doctor to make a definitive diagnosis of Parkinson’s disease during stage 1.
This stage is not quite different from the first stage except that the neck and spine are now involved.
During this stage of PD, the symptoms affect both sides of the body (bilateral involvement), but the balance is not impaired. It may take months or years from the first stage to progress to the second stage. Changes in posture and gait are now more apparent. The person may start experiencing problems with speech such as slurring words or being unable to control the tenor of his or her voice. Increased stiffness, loss of facial expression control is seen in this stage, too. All these symptoms will have some, albeit minimal, disabling effect and cause interference with day-to-day living. This stage still is not easy to diagnose, as sometimes the symptoms are simply attributed to being part of ageing.
In this stage, the person will start to experience a mild impairment of balance, but still no loss of balance. The “pull test” is usually performed to see the extent to which the balance has been affected. The test involves a doctor standing behind the person and asking him/her to maintain his/her balance when he pulls him/her back. The person will have to take three or more steps to recover the balance when he or she is pulled backwards which is indicative of having reached this stage.
In this third stage, Parkinson’s disease significantly advances, and it is often considered mid-stage in the entire progression of the disorder. Loss of balance is finally experienced, and the pull test is performed to check. If the person does not regain his/her balance and the doctor must catch the person to prevent a fall, it is said that his/her balance is impaired. Body movements also start to slow down noticeably during the third stage—a manifestation medically referred to as bradykinesia. The doctor will find it easy to make a definite diagnosis when the person has gotten to this stage of Parkinson’s disease. Disability is apparent at this stage, and the person may find it more difficult to perform basic tasks like dressing and eating. It is, however, still possible to be able to carry out daily activities without external help. Depending on the kind of work he/she does and how much physical dexterity it requires, he/she may also still be able to remain employed.
The persons’ symptoms become severe in this stage. He/she will become unable to perform his/her daily tasks without assistance, it will be incredibly challenging, making independent living almost impossible. The body parts and the slowness of movement become significantly worse. It is still possible to stand and walk, but it may be difficult and using a walker may make it easier.
This is the most advanced stage of PD, as most (or all) other symptoms previously experienced worsen. It becomes impossible to move around unaided and a wheelchair is necessary. The person will be unable to perform his/her daily living tasks such as eating, dressing up, and bathing. Due to this, constant nursing care is necessary to prevent falls and other accidents from happening. Some people also experience delusions, dementia, hallucinations, and confusion at this stage. It is important to know that Parkinson’s disease, unlike some other conditions, is a highly individual one, and the way people experience its symptoms can vary wildly. For example, some people may never reach stage 5 of PD. In uncommon cases, a person’s symptoms may become severe but still be limited to just one side of the body. Medically, these stages are used as a loose guide, and in fact, they make up one of the sections in the Unified Parkinson’s Disease Rating Scale (UPDRS). The UPDRS is the widely accepted method of classifying, monitoring, and managing the progress of Parkinson’s disease (Ajiboye & Chaves: 2021).
I have been able to have a family and to dedicate quality time to my two sets of twins and my husband, as well as to serve on the boards of The Michael J. Fox Foundation for Parkinson’s Research and Montefiore Medical Center (Karen Finerman)