Parkinson’s disease is a condition of the central nervous system that progressively affects movement. Symptoms usually begin on one side of the body and worsen with time. Typical motor symptoms include tremors, muscle rigidity, slowness of movement (bradykinesia), and reduced posture and balance.

Over time, people may experience difficulties in speaking, writing, or doing other fundamental movements such as smiling. Not everyone is affected in the same way, and the disease progresses faster in some than it does in others.

Rating scales

Two rating scales are commonly used to assess the progression of the condition, the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Hoehn and Yahr scale.

Unified Parkinson’s Disease Rating Scale

The UPDRS contains four parts. The first part assesses intellectual function, mood, and behavior. The second one assesses activities of daily living. The third part assesses one motor function, and the fourth assesses motor complications.

Each part includes scores that altogether rate the severity of the disease. The maximum score is 199, reflecting total disability, whereas a score of zero means no disability.

Hoehn and Yahr scale

This scale, introduced in 1967, was the first to describe the progression of Parkinson’s disease. It contains five stages of disease progression and still serves as a basis for the definition of different Parkinson’s disease stages. In the updated version currently used, stages 1.5 and 2.5 were added to account for the intermediate course of the disease.

Parkinson’s stages

Stage 1

This is the initial stage characterized by mild symptoms such as rigidity, tremors, or slowness of movement in the leg or arm on one side of the body. The symptoms at this stage usually do not affect daily activities. Changes in facial expression may be noticed by the patient’s close relatives and friends.

Stage 1.5

This stage is similar to stage 1. The body axis starts to be affected, but without impairment of balance.

Stage 2

Symptoms start to worsen at this stage with tremor, rigidity, and other movements affecting both sides of the body and the body axis. Problems with walking and poor posture are noticeable. Daily activities become more difficult, but the person is still able to live independently.

Stage 2.5

This stage is similar to stage 2, and body balance starts to become impaired. The patient is, however, still able to recover from the so-called pull test that is used to assess stability. In this test, someone pulls the patient backward on the shoulders, and the patient’s ability to recover shows how severely their balance is affected.

Stage 3

This is the mid-stage of the disease characterized by loss of balance and slowness of movement. Falls become more common during this stage. The patient is, however, still able to live alone, and able to do daily activities such as dressing or eating.

Stage 4

In this stage, symptoms are severe and very limiting. It is still possible for the patient to stand without assistance, but he or she is not able to live alone and needs help with daily activities.

Stage 5

This is the most advanced and debilitating stage of the disease. Patients have great difficulty walking or standing. They are not able to live alone and require a wheelchair to move around. Assistance is needed in all daily activities. Besides motor symptoms, the person may see, hear, or experience things that are not real (hallucinations), or believe things that are not true (delusions).

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Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Ana holds a PhD in Immunology from the University of Lisbon and worked as a postdoctoral researcher at Instituto de Medicina Molecular (iMM) in Lisbon, Portugal. She graduated with a BSc in Genetics from the University of Newcastle and received a Masters in Biomolecular Archaeology from the University of Manchester, England. After leaving the lab to pursue a career in Science Communication, she served as the Director of Science Communication at iMM.