Like other age-related diseases including Alzheimer’s, Parkinson’s is a neurodegenerative condition which worsens over time leading to debilitating disability and lack of basic functioning. The ultimate cause of Parkinson’s? Missing dopamine.
Known most commonly as the brain chemical responsible for the reward center of the brain, dopamine is a neurotransmitter required for the communication between neurons (brain cells) in the substantia nigra region of the brain. In patient’s with Parkinson’s, the brain cells which produce dopamine are either damaged or die off, leading to a host of symptoms including impaired motor function, tremors, and loss of autonomic functions. Autonomic functions, or those things your body does without even ‘thinking’, include blinking, smiling, swinging your arms at your side when walking, swallowing, temperature control, and more.
Parkinson’s Disease is typically diagnosed after age 60, but symptoms, onset, and degree of severity can vary greatly across patients. Even so, researchers and medical teams have devised a reliable framework for recognizing the stages of Parkinson’s as it progresses. The Hoehn and Yahr scale first introduced in 1967 covers a basic progression of symptoms associated with Parkinson’s, primarily focused on motor skill degeneration. It has been updated in the decades since to capture more intermediate symptoms and is still in use in the neuroscience field today.
The Unified Parkinson’s Disease Rating Scale (UPDRS) is most commonly used in the clinical study of Parkinson’s Disease and elaborates on symptoms outside of just motor impairment, including mood, behavior, social interaction, and mental functioning. This more comprehensive approach to diagnosing and staging the disease can help people better understand and cope with its progression.
The stages of Parkinson’s include:
- Stage I: Minor changes in walking, posture, and facial expressions occur and may be noticed by friends or family. These might include not smiling or not swinging your arms at your side when walking. Mild tremors may begin, specific to one side of the body, possibly including a ‘pill rolling tremor’ where the thumb and pointer finger seem to rub together on the hand.
- Stage II: Symptoms worsen and mobility becomes impacted with apparent difficulty with walking and posture. Tremors may affect more than one side of the body, and rigidity of the muscles sets in. Completing day to day tasks becomes more problematic, and basic functions like speaking or writing take longer than normal.
- Stage III: While a patient may still remain independent at this mid-stage of the disease, day to day functions like getting dressed and eating become drastically slower. Loss of balance, impaired mobility, and frequent falls characterize this stage.
- Stage IV: Symptoms are severe, mobility and range of motion of limited, and autonomic functions like blinking regularly and swallowing saliva may start to slow. Patients in this stage will require assistance with daily activities and likely not live on their own.
- Stage V: Fully immobilized, a patient in this final stage of Parkinson’s will have limited range of motion from leg stiffness and tremors, and may be limited to a bed or recliner, unable to walk or stand. They will require full-time skilled nursing care and may even experience hallucinations or delusions.
Additional non-motor specific symptoms may include:
- Excessive sweating
- Trouble smelling
- Low blood pressure
- Sleep disorders
- Vision problems
- Pain
- Fatigue
- Personality changes
- Slowness in thought and speech
- Trouble focusing
- Depression or anxiety
- Incontinence
- Vision problems
Assistive devices like mobility aids, shower safety rails, dressing hooks, and car transfer devices can support someone with Parkinson’s (and help their caregivers) as the disease worsens over time. With a Parkinson’s diagnosis, effective medication and even brain surgery may be administered to help mitigate symptoms and slow down the progression of the disease. Pharmacological intervention might include taking medicine (by pill, IV, or patch) which helps to produce or mimic the dopamine in the brain.
The good news? Continued research is providing insight into the disease including its causes and a potential cure. While some patients progress quickly through the disease, others live with Parkinson’s successfully for decades. The more knowledge and information you have on hand, the better equipped you are to manage a degenerative disease like Parkinson’s.
Joe Fleming
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