Recognizing the Progression of Parkinson's Disease Symptoms

The progression of Parkinson's disease symptoms can take 20 years or even longer. But the rate of progression varies from person to person.

To give patients an idea about how far their disease has progressed, many doctors use the Hoehn and Yahr scale for the staging of Parkinson's disease, which is broken down into the following stages:

• Stage one: Parkinson's disease symptoms affect only one side of the body.

• Stage two: Symptoms begin affecting both sides of the body, but balance is still intact.

• Stage three: Parkinson's disease symptoms are mild to moderate and balance is impaired, but the person can still function independently.

• Stage four: People with stage four Parkinson's disease are severely disabled, but they can still walk or stand without assistance.

• Stage five: The patient becomes wheelchair-bound or bedridden, unless someone is helping him.

While your doctor may be able to tell you how far along you are on this scale, there is no accurate way of predicting how soon you will get to the next stage. However, you can expect that as you notice your symptoms worsening, your physical functioning will also start to decline.

Parkinson’s Disease Symptoms: Dementia

Some Parkinson's disease patients experience dementia, or impairment of mental functioning. About 0.2 percent to 0.5 percent of those with Parkinson’s over age 65 will have problems with dementia, including trouble with their memory, attention spans, and what is called executive function — the process of making decisions, organizing, managing time, and setting priorities.

How Parkinson’s Disease Symptoms Respond to Treatment

There is no cure for Parkinson's disease, but treatments can help ease your symptoms.

Tracking your response to treatment is another way doctors can 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 your symptoms begin affecting your functioning, the Parkinson's medication Sinemet or Parcopa [carbidopa and levodopa]) is usually able to significantly and effectively reduce symptoms for one to five years — longer in about 25 percent of patients.

3. Waning medication response. When the effectiveness of Sinemet or Parcopa begins to wear off (its effects will last for increasingly shorter periods of time as the disease progresses), you will need to increase the amount of medication, or add another medication called a COMT inhibitor [Comtan (entacapone); Tasmar (tolcapone)] that essentially boosts the efficacy of the carbidopa/levodopa combo.

4. Unpredictable medication response. Instead of occurring at predictable intervals, breakthrough symptoms begin occurring at random, and may be triggered by stress and anxiety. At this point, medications will need to be continuously monitored, and Parkinson's surgery may become a treatment option.

5. Dyskinesias. Dyskinesias are involuntary movements that tend to occur when your medication dose has reached its peak performance. When this happens, adjusting your medication dosing, taking a medication called Symmetrel (amantadine), and perhaps surgery may also help.

6. Severely unpredictable symptoms. In the most advanced stages of Parkinson's disease's, severe symptom flare-ups alternating with severe dyskinesias will occur, despite medication adjustments. At this point, surgery is often the best treatment option. Called deep brain stimulation, this surgery involves implanting electrodes in the brain that are connected to an external device somewhat like a heart pacemaker that helps 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. However, when the disease is in its advanced stages, Parkinson's disease symptoms can lead to life-threatening complications, including:

•Falls that lead to fractured bones

• Pneumonia


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 good news may be on the horizon. Researchers believe that they will one day find ways to halt the progression of Parkinson's disease and even restore lost functioning.

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6 Replies

  • The stages don't make any sense to me.

    Stage four: People with stage four Parkinson's disease are severely disabled, but they can still walk or stand without assistance.

    How can you be severely disabled but still walk or stand without assistance? I need a walker to get around and often need a cane.

    Response to med: I guess I'm at number 4.

  • I don't want to get people's hopes up, but I have to say that in my case, it wasn't like this. I am no longer on medication and live a normal life, although I still have most of the symptoms. The story is too long to print here.

    If you want to know what I did, you can either visit my website - - at no cost to yourself or you can buy my book on the website, which will be delivered to you at no extra cost.

    I am not selling a product or anything that will cost you a cent. All you need is to find out what you can do to help yourself.


  • It seems it's all a matter of perspective (and semantics?). As for myself, I have a hard time calling it a "normal life" while I "still have all the symptoms" of PD.

    Forgive my bluntness, but buying a book about "Reversing Parkinson's" from someone who still has "all the symptoms" of PD but chooses to define them as "normal" fails to strike me as a sound investment.

  • Hi metacognito. What is 'normal'?. To me, normal is getting up every morning, facing whatever comes up during the day and interacting with other people and seeing friends and relations, then going to bed at night, in one piece. To you, 'normal' might be something totally different.

    I am nearly eighty years of age. I manage to walk over four miles in an hour, three times a week. That is not normal in this retirement village I live in, but to me, that is normal. I still travel overseas and all around our country, meeting other people and talking about living with Pd. Nobody else I know of my age is as active as that, but to me, that is normal. I have done it for years. I have just remarried for the second time in my life and that is not heard of very often. I was married the first time for 51 years, and that is not normal either, these days, but to me, it was. I hope you understand where I am coming from. We all make our own 'normal'. If we don't we are not in control of our own lives.

    Good luck.


  • That's great hearing all that about your definition of "normal". Now, back to the point of my comment... - how do you account for your claims of "Reversing Parkinson's" (in the context of you admittedly continuing to experience "most of the symptoms").

  • Hi metacognito. As I have stated in many blogs, I am not a doctor. I am a very 'normal' sort of person. I did not ask to get Pd, it came uninvited. For two years I gave in to it and went downhill very fast. When I came to my senses I decided to do something about it! I thought that if Pd is a movement disorder, I was going to do as much 'moving' as I could. Hence my concentration on exercise, but I had already been doing a great deal of exercise since 1970 and was still going downhill. By sheer good fortune, my wife had been participating in a walking program, which had enabled her to lose 14 Kilograms of weight and she had also got over the need to take any blood pressure medication. I had given up going to the gym, two years after diagnosis and was prepared to just sit and read, watch TV and let it all happen. Shirley was very agitated by my capitulation. She begged me to try the walking. What good could walking, three times a week do me, when I had been walking for 20 minutes every day, six days of the week, plus rowing for 20 minutes, plus step climbing for 20 minutes, and on top of all that, pushing weights on various machines for another half hour? She would not let-up. I gave in and joined her walking group. Surprise, surprise! I started to get better! I am not going to explain this for the umpteenth time. Fast walking has been proven to produce a substance called GDNF in the brain and that substance is the reason, in my mind, why I am so well. I also gave up my job and all the stress that went with it. The Eldepryl also played a major roll in this story. Read all about it and satisfy yourself that I am not making it all up.

    Join the ranks of the converted!


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