Progression of parkinson disease

Parkinson’s stages: Signs and symptoms

Parkinson’s disease is broken into five stages. Each stage presents changing or new symptoms that a person is likely to encounter.

Dividing the disease into stages helps doctors and caregivers understand and address some of the challenges a person is experiencing as the disease progresses.

Stage 1

Share on PinterestThe five stages of Parkinson’s measure the severity of symptoms.

During the initial stages of Parkinson’s disease, the symptoms are typically not severe. A person can perform everyday tasks with minimal issues, so many of the signs and symptoms of stage 1 can be missed.

Some signs and symptoms of this stage include changes in:

  • posture
  • facial expressions
  • walking

In addition, a person may experience mild tremors on one side of the body. A doctor might prescribe medication at this stage that will help control the symptoms.

Stage 2

Tremors, trembling, and stiffness affect both sides of the body in stage 2 of the disease and are much more noticeable.

The increased stiffness is often enough to delay tasks. A person may find it difficult to maintain independent living, according to their age and other factors.

Walking, speech, and posture problems are often more noticeable in stage 2 of Parkinson’s.

Stage 3

Stage 3 or mid-stage Parkinson’s disease is characterized by an increase in symptoms. A person will experience most or all of the symptoms of stage 2, plus:

  • problems with balance
  • slow movements
  • slow reflexes

A person with stage 3 Parkinson’s must be aware of the increased likelihood of falling due to coordination issues. Dressing and other self-care tasks may become more difficult.

Treatment at this stage often involves both medication and occupational or physical therapy. Some people respond favorably to treatment, while others may not experience much improvement.

Stage 4

During stage 4 Parkinson’s, daily activities may be challenging or even impossible. It is likely that a person will require some form of daily care, as independent living is not usually possible.

People at this stage may be able to stand on their own but may need a walker or other assistive device to walk.

Stage 5

Stage 5 is the last and most debilitating stage of Parkinson’s disease. A person will not be able to stand or move around due to stiffness. Depending on their age and health, they may be bedridden or use a wheelchair for mobility.

Unlike earlier stages, a person will need constant nursing aides. Aides will help the person do daily activities and prevent dangerous situations or accidents from occuring.

In stage 5, a person may also experience:

  • hallucinations
  • delusions
  • dementia
  • poor response to medication
  • confusion

Parkinson’s Disease and Caregiving

Side Effects

As with all medications, side effects can be a problem. For some, starting Sinemet may cause dizziness or nausea. These symptoms may be most severe when the person first begins taking the drug and gradually disappear or lessen with time. Sometimes adding extra “carbidopa” with each tab of Sinemet helps control the nausea.

For other medications, side effects may appear after several years. For example, long-term levodopa use may result in large uncontrollable movements (dyskinesias) or “off” periods where the person becomes frozen (can’t move) until the next dose of medication is taken or a sensory trick is used (for example, counting out loud, like a march, “One, two, three.”) Another side effect in the more advanced stages and from larger doses of dopaminergic medications are visual hallucinations, where people at first see things in the corner of their visual field. Sometimes these hallucinations can be frightening.

There is a well-described side effect from dopamine agonists that everyone who starts this class of medication should know about. Agonists and higher doses of Sinemet may cause impulse control (behavioral) problems. These behaviors vary, but may include: excessive spending, gambling, sex, pornography, or hoarding behaviors. Often reducing or stopping this class of medications stops the behavior. These behaviors can be so embarrassing for the care recipient and their family that too often the topic is avoided when talking with the doctor. Odd as it may feel, keeping track of unusual impulse behavior to report to the neurologist can provide critical medical management information.

Sometimes, in the most advanced stages, a choice has to be made between motor function and cognitive function. High doses of medications may be required to manage the motor symptoms, but these same doses cause hallucinations or paranoia. At this point, a team meeting with all the medical providers and the family is advised to discuss the need to adjust the medications causing the side effects, yet balance the need to help the patient’s motor symptoms. Sometimes adding an anti-psychotic medication (such as quetiapine/Seroquel) is helpful. A multidisciplinary team meeting adds value and can help the family weigh the pros and cons of the PD medications with the caregiver and patient’s quality of life.

Surgery and Deep Brain Stimulation

Deep brain stimulation (DBS) is a treatment for Parkinson’s disease that uses an implantable pacemaker-like device to deliver electrical pulses to parts of the brain involved in movement. The DBS system consists of leads precisely inserted into a specific brain target, the neurostimulator (pacemaker) implanted in the chest, and extension wires that connect the leads to the neurostimulator. Though implantation of the system (DBS surgery) requires a neurosurgical procedure, the treatment itself consists of long-term electrical stimulation. Advantages of DBS include its ability to reduce the high doses of medications (avoiding the systemic side effects of medication), its adjustability (stimulation settings are programmed non-invasively using a wireless programmer by the clinician or a patient programmer), and its reversibility (can turn it on or off.) DBS was approved by the Food and Drug Administration as a treatment for PD in 2002 and according to Medtronic (the manufacturer of the DBS system), more than 80,000 patients have undergone DBS surgery worldwide.

Typical candidates are those who have motor fluctuations or periods of “off” time with troublesome symptoms alternating with periods of “on” time with good symptom control, and also with possible periods of excessive movement (dyskinesia).

Not all patients with Parkinson’s disease are good candidates for treatment with DBS. Approximately 10–20% of patients considered for possible treatment with DBS include those:

  • With idiopathic (arising from unknown cause) Parkinson’s disease and not an atypical variety of parkinsonism
  • Who still respond, even if briefly during the day, to levodopa-containing medication
  • Who are significantly troubled by motor symptoms of Parkinson’s disease (slowness, stiffness, shaking, or other movement problems), despite taking an optimized regimen of medications
  • Who do not have significant problems with memory or other cognitive functions
  • Who do not have significant or untreated mental health issues, like depression or anxiety
  • Who have considered the likely benefits and potential risks of DBS and find this assessment acceptable for their situation
  • Have reasonable expectations for what DBS likely will and will not do for them

Individuals whose condition meets these criteria are advised to seek a comprehensive evaluation from an experienced DBS team. This may be accomplished by requesting a referral from the patient’s neurologist to a DBS center. The best candidates who have the most robust response to DBS tend to be younger than 70 years of age, with few center of the body symptoms such as swallowing and balance problems.

Non-Medical Interventions for Parkinson’s Disease

Many caregivers and individuals with Parkinson’s disease are interested in complementary therapies to supplement medications and other traditional PD treatments. Increasingly, studies are showing that recreational physical activities such as walking, swimming, dance, yoga, and Tai Chi can play an important role for individuals living with Parkinson’s disease. Although there is no evidence that non-medical activities can affect disease progression, physical activity may assist with management of the symptoms of the disease while helping to increase enjoyment of life by staying active, having fun, and learning new skills. Innovative programs are increasingly available. For example, one popular program started in New York and replicated in other states and countries offers dance classes for individuals with PD. A San Francisco Bay Area Parkinson Group partnered with the Mark Morris Dance Group, a highly regarded modern dance company, to develop dance classes for persons with Parkinson’s disease, friends, and family. Professional dancers teach the classes in a large dance studio with live piano accompaniment (See the References section of this fact sheet for more information on these and other programs).

Consult your doctor and Parkinson’s care team regarding the type of movement you would like to pursue. They can recommend how hard you should be working (intensity) and the duration of the activity. A recommendation from your doctor to consult with a physical, occupational, or speech therapist is often useful. These professionals can assist you in evaluating how to use non-medical interventions in a way that best suits your needs.

Related Diagnosis: Lewy Body Dementia (LBD)

Current research is helping to differentiate dementia related conditions in relationship to Parkinson’s disease. Doctor’s use a 12-month arbitrary rule to aid in diagnosis. When dementia is present before or within 1 year of Parkinson’s motor symptoms developing, an individual is diagnosed with DLB. Those who have an existing diagnosis of Parkinson’s for more than a year, and later develop dementia, are diagnosed with PDD.

In the simplest terms, Lewy bodies are abnormal clumps of proteins that develop in nerve cells. Cholinesterase inhibitors, medications originally developed for Alzheimer’s disease, are the standard treatment today for cognitive DLB and PDD symptoms. Early diagnosis is important, as DLB patients may respond differently than Alzheimer’s disease patients to certain drug, behavioral, and dementia care treatments.

Studies show that 10% to 70% of those living with PD will develop some degree of dementia (loss of brain function). This loss affects memory, thinking, language, judgment, and behavior. A few of the signs of dementia in PD include slowed thinking, a more passive (or apathetic) personality, memory problems, and trouble with decision-making. One particularly troubling symptom for a caregiver is when a care recipient experiences vivid hallucinations or delusions—seeing or hearing things that are not really present but seem very real to the individual. Frightening or dangerous hallucinations may call for a medical intervention. Use of certain antipsychotic medication can have highly debilitating side effects due to a hypersensitivity to these drugs by many LBD patients. Highly cautious use and careful monitoring by your doctor is critical should the use of these drugs become necessary. It’s also important to note that people living with LBD may or may not experience worsened hallucinations and delusions from medication used for PD, such as levodopa. An individual can also experience disease-induced episodes of paranoia and have sleep/wake cycle disruption.

This challenging, multi-system disorder involving movement, cognition, behavior, sleep, and autonomic function requires a comprehensive treatment approach to maximize the quality of life for both the care recipient and their caregiver. It is very important to pay attention to symptoms of dementia and to search for an expert clinician who can diagnose the condition accurately.

Depression, which is common in both PD and LBD, can display the same symptoms as Alzheimer’s disease. Therefore it is important to work closely with a physician to rule out other possible causes for the changes in behavior and thinking. Please see the Resources section of this fact sheet to find organizations and other resources dedicated to helping you learn more about these complex dementia related Parkinson’s conditions.

Support for the Caregiver

Get Prepared

Many resources are available online (See the Resources section of this fact sheet for more information), and public libraries have literature on the disease. Whenever possible, accompany the person with Parkinson’s to their medical appointments and ask questions of the doctor, nurse, and social worker.

The areas to assess include your loved one’s needs—both your perceptions and theirs, your home environment, and your own health, emotional state, and other commitments. The caregiver has to determine how much they can and can’t do themselves and what type of outside support is needed. It is also important to assess current and future financial issues such as health insurance coverage, employment (both caregiver and the person with Parkinson’s), managing expenses, and if/when to secure Power of Attorney.

Take Care of Yourself

Probably one of the most important, and sometimes difficult, things caregivers can do is to take care of themselves. This includes maintaining mental and physical health by making and keeping your own medical and dental appointments. As a caregiver, it is important to keep your job whenever possible as it provides not only financial help and possibly insurance coverage, but also a sense of self-esteem. Join a support group for caregivers if possible. Support groups help you meet people who are going through what you are going though, vent frustrations, give and receive mutual support, and exchange resource information and coping strategies. Whenever possible get your sleep, take breaks, make and keep social activities, and try to keep your sense of humor.

Get Help

Get help—don’t try to do it all alone. By getting help, a caregiver can lessen their sense of isolation, and it gives you more confidence in your own caregiving ability. Having help increases your ability to think creatively and helps you get those needed breaks. Help is available through local and community services. These include neighbors, friends, churches, synagogues, senior centers, adult day health, Meals on Wheels, and door-to-door vans. For a fee there is in-home care for help with cooking, bathing, dressing, and meal preparation. Additionally, a social worker from your health plan or hospital can connect you with other services.

Foster a Good Relationship

Lastly, maintaining your relationship and communication with the person with Parkinson’s can be the most challenging and rewarding aspect of caregiving. As Parkinson’s disease progresses, the roles change and the person with Parkinson’s may go from being an independent head of the household to a very dependent person requiring a significant level of care. However, research shows that despite high levels of strain, caregivers with good quality relationships have reduced depression and better physical health. Remember, as a caregiver your service to your loved one is beyond measure in terms of love, depth of care, and concern.


Family Caregiver Alliance
National Center on Caregiving
FCA CareJourney:
Family Care Navigator:

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research, and advocacy. Through its National Center on Caregiving, FCA offers information on current social, public policy, and caregiving issues and provides assistance in the development of public and private programs for caregivers. For residents of the greater San Francisco Bay Area, FCA provides direct support services for caregivers of those with Alzheimer’s disease, stroke, traumatic brain injury, Parkinson’s, and other debilitating health conditions that strike adults.

Organizations and Other Links

American Parkinson Disease Association

National Parkinson Foundation

Parkinson’s Disease Research, Education and Clinical Center
San Francisco VA Medical Center

Parkinson’s Patients Support Groups, Inc. of Northern and Central California

Parkinson’s Symptoms

Parkinson’s disease most commonly begins with a tremor in one hand but can also cause limb stiffness or slowness of movement without tremor. Or, perhaps, someone else may notice that you’re not swinging your arm normally as you walk. “Sometimes these symptoms are mild and not really that disruptive,” says Gwenn Smith, Ph.D., director of the Division of Geriatric Psychiatry and Neuropsychiatry at Johns Hopkins Bayview Medical Center. “But they indicate that you should see a neurologist for an evaluation.”

Symptoms of Parkinson’s disease are separated into three categories: primary motor symptoms, secondary motor symptoms and nonmotor symptoms. Here’s what you need to know:

Primary Motor Symptoms

Resting tremor: This happens when a body part on one side of the body (usually a hand or foot) shakes slightly when you’re not using it (hence “resting”). The tremor usually stops when you start doing something with that hand or other body part.

Bradykinesia: The definition of bradykinesia is slow and small movement. You may not be able to walk at your normal pace, step size might be smaller or you may perform repeated movements more slowly (think tapping your fingers on a table). Some examples of this are:

  • Freezing of gait: This is when you attempt to take a step forward and suddenly feel as though you can’t, as though your foot is “stuck” to the floor. Sometimes it’s temporary, and once you do start walking, the freezing goes away.

  • A “mask” face: Possibly as a result of a combination of rigidity and bradykinesia, your facial expression may look flat or masklike. What happens is your facial muscles lose some of their involuntary movements.

  • Micrographia (smaller handwriting): The result of bradykinesia, your ability to perform repetitive motions decreases, leading to smaller, more cramped handwriting.

Rigidity: This occurs when muscles remain tense rather than contracting and relaxing as normal, and is often described by patients as stiffness. Combined with bradykinesia, it’s what causes such phenomena as walking without swinging your arms in a normal motion.

Postural instability/poor balance: This symptom occurs when you find it hard to remain upright, either when standing or as you rise from a chair. It may feel as though you’re tipping backward. You may find it harder to make a quick turn or pivot without tending to fall.

Nonmotor Symptoms

Constipation: If you have difficulty with bowel movements that can’t be explained by other factors — a diet low in fiber or water, or the use of certain medications — it can be a sign of Parkinson’s disease.

Hyposomia: This is a loss of some of your sense of smell, and it’s common in Parkinson’s (though it may also be overlooked as an early symptom). This may also secondarily affect the sense of taste, given that odor is heavily involved in flavor. One theory is that the same clumping of the protein alpha-synuclein that occurs in the part of the brain that controls dopamine receptors also happens in the olfactory bulb, which controls sense of smell.

REM sleep behavior disorder: This is when people seem to “act out” their dreams. You may thrash around in bed in your sleep or even fall out of bed.

Mood disorders: Psychological issues, such as depression and anxiety, can be an early sign of Parkinson’s disease and may arise long before motor symptoms do.

Urinary frequency/urgency: Patients with Parkinson’s disease often feel the need to urinate more urgently, even when their bladder is not very full. Getting to the bathroom quickly is often complicated by the movement problems mentioned above.

What Are the Stages of Parkinson’s Disease?

Although Parkinson’s disease (PD) is progressive and worsens over time, it is highly individual and affects people differently. Not all people who have PD will experience all the symptoms, and symptoms may vary in their severity between patients. Different people experience progression at different speeds, as well. However, physicians have established stages that describe how the disease progresses. These five stages of Parkinson’s are known as the Hoehn and Yahr Scale used by physicians throughout the world to classify patients in research studies.1,2

Stage one of Parkinson’s disease

In stage one, the earliest stage, the symptoms of PD are mild and only seen on one side of the body (unilateral involvement), and there is usually minimal or no functional impairment.

The symptoms of PD at stage one may be so mild that the person doesn’t seek medical attention or the physician is unable to make a diagnosis. Symptoms at stage one may include tremor, such as intermittent tremor of one hand, rigidity, or one hand or leg may feel more clumsy than another, or one side of the face may be affected, impacting the expression.

This stage is very difficult to diagnose and a physician may wait to see if the symptoms get worse over time before making a formal diagnosis.

Stage two of Parkinson’s disease

Stage two is still considered early disease in PD, and it is characterized by symptoms on both sides of the body (bilateral involvement) or at the midline without impairment to balance. Stage two may develop months or years after stage one.

Symptoms of PD in stage two may include the loss of facial expression on both sides of the face, decreased blinking, speech abnormalities, soft voice, monotone voice, fading volume after starting to speak loudly, slurring speech, stiffness or rigidity of the muscles in the trunk that may result in neck or back pain, stooped posture, stooped posture, and general slowness in all activities of daily living. However, at this stage the individual is still able to perform tasks of daily living.

Diagnosis may be easy at this stage if the patient has a tremor; however, if stage one was missed and the only symptoms of stage two are slowness or lack of spontaneous movement, PD could be misinterpreted as only advancing age.

Stage three of Parkinson’s disease

Stage three is considered mid-stage and is characterized by loss of balance and slowness of movement.

Balance is compromised by the inability to make the rapid, automatic and involuntary adjustments necessary to prevent falling, and falls are common at this stage. All other symptoms of PD are also present at this stage, and generally diagnosis is not in doubt at stage three.

Often a physician will diagnose impairments in reflexes at this stage by standing behind the patient and gently pulling the shoulders to determine if the patient has trouble maintaining balance and falls backward (the physician, of course, will not let the patient fall). An important clarifying factor of stage three is that the patient is still fully independent in their daily living activities, such as dressing, hygiene, and eating.

Stage four of Parkinson’s disease

In stage four, PD has progressed to a severely disabling disease. Patients with stage four PD may be able to walk and stand unassisted, but they are noticeably incapacitated. Many use a walker to help them.

At this stage, the patient is unable to live an independent life and needs assistance with some activities of daily living. The necessity for help with daily living defines this stage. If the patient is still able to live alone, it is still defined as stage three.

Stage five of Parkinson’s disease

Stage five is the most advanced and is characterized by an inability to rise from a chair or get out of bed without help, they may have a tendency to fall when standing or turning, and they may freeze or stumble when walking.

Around-the-clock assistance is required at this stage to reduce the risk of falling and help the patient with all daily activities. At stage five, the patient may also experience hallucinations or delusions.

While the symptoms worsen over time, it is worth noting that some patients with PD never reach stage five. Also, the length of time to progress through the different stages varies from individual to individual. Not all the symptoms may occur in one individual either. For example, one person may have a tremor but balance remains intact. In addition, there are treatments available that can help at every stage of the disease. However, the earlier the diagnosis, and the earlier the stage at which the disease is diagnosed, the more effective the treatment is at alleviating symptoms.

Figure 1. Stages of Parkinson’s disease

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Mayo Clinic Q and A: Rate of progression of Parkinson’s disease hard to predict

DEAR MAYO CLINIC: My father is 64 and was diagnosed with Parkinson’s last year. So far his symptoms are very mild, but I’m wondering what the typical progression of the disease is like. I have read that deep brain stimulation is sometimes recommended. When is this type of treatment usually considered? Is it safe?

ANSWER: The symptoms of Parkinson’s disease, or PD, tend to begin very gradually and then become progressively more severe. The rate of progression is hard to predict and is different from one person to another. Treatment for PD includes a variety of options, such as exercise, medication and surgery. Deep brain stimulation is one surgical possibility for treating PD, but it’s usually only considered in advanced cases when other treatments don’t effectively control symptoms.

Parkinson’s disease is a syndrome which typically has no known cause. The diagnosis is based on symptoms. Neurologists who specialize in movement disorders typically have the most experience with PD diagnosis and treatment. There are many symptoms of parkinsonism. The most common include excessive slowness and lack of movement, as well as shaking or tremor.

As in your father’s situation, symptoms are often mild at the outset. How quickly they get worse varies substantially, perhaps because there may be multiple underlying causes of the disease. In most cases, symptoms change slowly, with substantive progression taking place over the space of many months or years.

Many people with PD have symptoms for at least a year or two before a diagnosis is actually made. The longer symptoms are present, the easier it is to predict how a person with PD will do over time. In those who have tremor and symptoms on one side of the body only, the disease typically advances more slowly than in those without tremor who have symptoms that affect both sides of the body, as well as walking.

While life expectancy is marginally reduced, people with PD usually function quite well for many years. They are, however, at an increased risk to develop instability that could lead to falls. They also have a higher risk for dementia. These two possibilities represent the greatest potential difficulties for those with PD.

While no treatment is currently available to slow the natural progression of PD, this condition is by far the most treatable of all neurodegenerative disorders. The vast majority of patients see major improvements in their symptoms with treatment that includes exercise and medication. For example, most people who have PD are able to function better in their daily lives five years after they start medication treatment than they were before they started treatment.

Surgery is only rarely required to treat PD, and usually is in the form of deep brain stimulation. This procedure involves placing an electrode into the brain that is connected to a battery. It delivers a small electric discharge into the brain, which influences the brain circuitry and improves symptoms.

Most people who undergo surgery for PD have had symptoms for at least five years. Surgery can be helpful when medications don’t consistently control symptoms or when tremor persists despite medication. Serious complication rates for deep brain stimulation surgery are low, with most institutions reporting a 1 to 2 percent risk for serious side effects.

Several other disorders similar to PD, known as atypical parkinsonism, have a less favorable long-term outlook than PD. In some cases, it can be hard to distinguish these conditions from PD. After several years of symptoms, however, determining the correct diagnosis is relatively straightforward.

Working closely with his neurologist, it is likely that your father will be able to achieve acceptable PD symptom control. It’s important that he contact his physician if he notices changes in symptoms, so treatment can be adjusted as needed over time. — Ryan Uitti, M.D., Neurology, Mayo Clinic, Jacksonville, Fla.

Researchers Discover The Earliest Signs of Parkinson’s Disease in The Brain

About 100 people have a rare mutation in a gene called SNCA that puts them at almost certain risk of getting Parkinson’s disease. This makes them ideal subjects for studying the root causes of this debilitating condition. Most of these people live in the northern Peloponnese in Greece, and a handful live in Campania, Italy. We were lucky enough to have 14 of these people agree to travel to London so we could study their brains.

More than 6 million people, globally, have Parkinson’s disease; it is the second most common neurodegenerative disorder after Alzheimer disease.

The symptoms, which worsen over time, include motor symptoms such as stiffness, slowness and shaking, as well as non-motor symptoms, such as memory problems. Researchers have been trying to find a reliable marker for the disease so that people at risk can be identified before the motor symptoms start.

There are no cures for Parkinson’s disease, but symptoms are treated with drugs that restore a brain chemical called dopamine to normal levels. Dopamine has long been considered a prime culprit in Parkinson’s disease as low levels cause problems with movement. But another brain chemical called serotonin has also been implicated in the disease.

But we didn’t know how early and to what extent changes in serotonin occur and if these changes are related to disease onset. To help answer this, we needed to study those Greek and Italian subjects with the SNCA gene mutation.

Studying these gene carriers before they develop Parkinson’s disease is a unique opportunity to understand what comes first in the cascade of events that eventually leads to a diagnosis of Parkinson’s disease. This knowledge is critical so that we can develop sensitive markers to track the progression of the disease.

People with the mutation tend to display symptoms of Parkinson’s disease in their 40s or 50s, so we wanted to study subjects in their 20s and 30s to see if there were any brain changes a decade or more before symptoms started.

Seven of our volunteers, who kindly visited our lab for ten days of brain imaging and neurological tests, had no motor symptoms and seven had been diagnosed with Parkinson’s disease.

We also examined 25 patients with sporadic Parkinson’s disease (Parkinson’s disease without a genetic cause) and 25 healthy volunteers.

All participant had three brain scans: one to measure dopamine, one to measure serotonin, and another to study anatomical regions in the brain.

We also carried out a series of clinical tests to investigate motor and non-motor symptoms. The volunteers wore an electronic device on their wrist for seven days to pick up any movements associated with Parkinson’s disease – movement that might be too subtle to be detected by a neurologist with the naked eye.

These tests confirmed that the seven subjects with the gene mutation who had no motor symptoms were, indeed, Parkinson’s free.

Early serotonin loss

Comparing data from the different groups allowed us to measure the severity of dopamine and serotonin loss at different stages of the disease, from people without symptoms to people with a diagnosis.

It also allowed us to compare changes seen in the gene carriers with changes seen in those with sporadic Parkinson’s disease. This helped us translate our findings in the gene carriers into the more common sporadic form of Parkinson’s disease.

We discovered that gene carriers without symptoms had depleted serotonin, while their dopamine neurons appeared to remain intact. So the changes in the serotonin system that we identified are likely to start very early and precede the onset of motor symptoms by some years.

Our study, published in Lancet Neurology, suggests that changes to the serotonin system come first, occurring many years before patients show symptoms. This important finding could lead to the development of new drugs to slow or even stop disease progression.

Our findings also suggest that brain scans of the serotonin system could be used as a tool for screening and monitoring disease progression. But these scans are expensive, so we need more work to develop affordable technology.

We also need more research into genetic forms of Parkinson’s which could further unlock the earliest changes underlying this awful disease.

Heather Wilson, Research Associate, King’s College London and Marios Politis, Lily Safra Professor of Neurology and Neuroimaging, King’s College London.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Recognizing the Stages of Parkinson’s Disease Progression

Parkinson’s disease is progressive: It gets worse over time. The primary Parkinson’s disease symptoms — tremors, rigid muscles, slow movement (bradykinesia), and difficulty balancing — may be mild at first but will gradually become more intense and debilitating.

Stages of Symptoms in Parkinson’s Disease

Parkinson’s symptoms can become more severe over a period of 20 years or even longer. How fast the symptoms intensify varies from person to person.

To find out how far the disease has progressed, many doctors use a rating scale called the Hoehn and Yahr Staging of Parkinson’s Disease:

  1. Stage one Mild symptoms affect only one side of the body.
  2. Stage two Symptoms affect both sides of the body, with posture and gait changes.
  3. Stage three Body movements are slow, and balance is impaired.
  4. Stage four Symptoms are severe and disabling, muscles become rigid, the patient can’t live alone, and walking is limited.
  5. Stage five Wheelchair-bound or bedridden, the patient needs constant care.

While your doctor may be able to tell you how far along you or a loved one is on this scale, how soon you’ll get to the next stage is not predictable. You can expect that as you notice your symptoms worsening, your physical functioning will also start to decline.

Parkinson’s Disease Symptoms of Dementia

Up to one-third of people living with Parkinson’s disease experience dementia, according to the Parkinson’s Disease Foundation. Problems with dementia may include trouble with memory, attention span, and what is called executive function — the process of making decisions, organizing, managing time, and setting priorities.

RELATED: 12 Famous People With Parkinson’s Disease

How Treatment Helps

Medical treatment to help restore the essential neurotransmitter dopamine, and at-home remedies like exercise, can help ease your symptoms. Although Parkinson’s disease has no cure, you can find out if you or a loved one is right for one of hundreds of clinical trials for Parkinson’s disease at the Fox Trial Finder.

Tracking your response to treatment helps determine how advanced your condition is. The stages of Parkinson’s treatment generally progress in the following order:

  1. No medication needed In its early stages, Parkinson’s disease symptoms may be very mild and may not need to be treated.
  2. Good response to medication As symptoms begin affecting your functioning, the Parkinson’s medication Sinemet (a combination of carbidopa and levodopa) can help. It is able to significantly and effectively reduce symptoms for 5 to 10 years in many patients, and longer in about 25 percent of patients. But it comes with side effects like tics and involuntary movements (called dyskinesias). Other Parkinson’s medications, called dopamine agonists, include Mirapex (pramipexole), Cycloset or Parlodel (bromocriptine), and Requip (ropinirole).
  3. Waning medication response When the effectiveness of a medication begins to wear off, you’ll need to increase the amount you’re taking or add another to boost the carbidopa-levodopa combo. Examples include MAO-inhibitors, such as selegiline and rasagiline, and COMT-inhibitors entacapone and tolcapone; these help therapy last longer.
  4. Unpredictable medication response Instead of occurring at predictable intervals, breakthrough symptoms may start to show up at random and may be triggered by stress and anxiety. At this point, medications will be continuously monitored.
  5. Dyskinesias These involuntary movements occur when your medication dose has reached its peak performance. Adjusting your medication dose — and perhaps surgery — may help.
  6. Severely unpredictable symptoms In the most advanced stages, severe symptom flare-ups alternate with severe dyskinesias, despite medication adjustments. At this point, surgery is a treatment option. Called deep brain stimulation, this surgery implants electrodes in the brain that are connected to an external device, somewhat like a heart pacemaker, to help control electrical impulses affecting movement and flexibility.

Parkinson’s Disease Symptoms: Life Expectancy

Even though Parkinson’s disease is a serious, progressive condition, it is not considered a fatal illness. People who have Parkinson’s disease usually have the same average life expectancy as people without the disease.

But when the disease is in its advanced stages, Parkinson’s symptoms can lead to life-threatening complications, including:

  • Falls that lead to fractured bones
  • Pneumonia
  • Choking

Thinking about the progression of Parkinson’s disease can be frightening. But proper treatments can help you live a full, productive life for years to come. And researchers hope to one day find ways to halt the progression of Parkinson’s and restore lost functioning.

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About Parkinson’s Disease

Nearly 1 million people in the U.S. are living with Parkinson’s disease, with between 50,000 and 60,000 new cases diagnosed each year, according to the National Parkinson’s Foundation.

Most cases occur in people over the age of 60, but some people develop the disease much earlier in life, as was the case with actor Michael J. Fox, who was diagnosed at age 30.

Parkinson’s is a chronic, progressive disease characterized by motor symptoms including tremors, muscle stiffness, and slowed movement. About a third of patients also develop dementia during the later stages of the disease.

There is no cure for Parkinson’s, but the drug levadopa and other medications can control symptoms for many years.

Because the clinical course of disease progression varies widely from patient to patient, identifying risk factors associated with early death could help doctors better target treatment strategies.

In an effort to do this, researchers from Norway’s Stravanger University Hospital analyzed data from 230 Parkinson patients participating in a larger study.

During the research period from 1993 to 2009, 211 patients died. The analysis revealed that:

  • The average time from the onset of symptoms to death was 16 years.
  • The average age at death was 81.
  • Patients with dementia were nearly twice as likely to die early as patients without memory problems.
  • Patients with a history of delusions, hallucinations, or other psychotic symptoms were almost 50% more likely to die early, compared to patients without the symptoms.
  • Men with Parkinson’s were about 60% more likely to die early than women.

Parkinson’s disease, a chronic, progressive movement disorder characterized by tremors and stiffness, is not considered a fatal disease in and of itself, though it may reduce life expectancy by a modest amount. It is often said that people die “with” Parkinson’s rather than “of” the disease.

“People who are healthy when diagnosed will generally live about as long as other people in their age cohort,” said James Beck, the vice president for scientific affairs at the Parkinson’s Disease Foundation, which is involved in research, education and advocacy. “It is not a death sentence.”

Since Parkinson’s generally affects people later in life — patients are typically given a diagnosis in their 60s — patients often die of unrelated age-related diseases like cancer, heart disease or stroke. But the most common cause of death in those with Parkinson’s is pneumonia, because the disease impairs patients’ ability to swallow, putting them at risk for inhaling or aspirating food or liquids into their lungs, leading to aspiration pneumonia.

Since Parkinson’s also impairs mobility and balance, those with the disease are also at high risk for falls and accidents, which can trigger a cascade of medical problems, including being bedridden and developing pneumonia, Dr. Beck said. In its advanced stages, the disease can make walking and talking difficult and cause other problems not related to movement, including cognitive impairment. Patients often cannot care for themselves and need assistance carrying out simple activities of daily living.

One long-term study followed a group of 142 Parkinson’s patients after they were given their diagnosis; their mean age at diagnosis was around 70. The researchers found that 23 percent were generally doing well 10 years later, meaning they could maintain their balance and did not have dementia. But over half of the patients in the original group had died, with the most common cause related to Parkinson’s being pneumonia. The probability of losing one’s ability to maintain balance after 10 years was calculated to be 68 percent, and the probability of developing dementia was around 46 percent.

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