Parkinson’s disease presents a multifaceted challenge, impacting individuals in diverse ways. While movement disorders such as tremors and bradykinesia (slowness of movement) are often the hallmark Parkinson’s disease symptoms, the disease’s progression and symptom presentation can vary significantly amongst patients. This is why understanding the distinct stages of Parkinson’s becomes crucial in adapting to the evolving nature of the disease. Continue reading to learn about how the disease progresses and the treatment options available for Parkinson’s disease.
Stages of Parkinson
While the disease affects individuals differently, understanding the five of Parkinson’s disease stages based on the Hoehn & Yahr scale can provide a helpful framework for navigating the progression and tailoring treatment:
Stage 1
Stage 1 Parkinson’s disease, often referred to as the earliest or mildest stage, can be a confusing and uncertain time for both individuals and their loved ones. While symptoms are present, they are typically subtle and may not significantly impact daily life.
For instance, mild symptoms usually of a resting tremor might be present in one hand or foot, but it may not be noticeable to others. Stiffness or reduced flexibility in limbs might be felt, but it’s unlikely to interfere with daily activities. Changes in posture or facial expression can occur, appearing subtly.
Due to the mildness of symptoms, Parkinson’s disease diagnosis at this stage can be challenging and might require specialised tests like DaT scans or dopamine transporter scans.
Stage 2
As individuals progress into Stage 2 of Parkinson’s disease, the symptoms become more noticeable and may start to impact daily activities. This stage is characterised by a moderate increase in the severity of motor symptoms, and individuals often find themselves facing new challenges.
Unlike Stage 1, symptoms are now likely to affect both sides of the body. Bilateral involvement becomes more pronounced, with tremors, slowness of movement, and rigidity impacting both limbs.
Parkinson’s disease treatments at this stage often focus on lifestyle modifications like exercise, physical therapy, and occupational therapy to manage symptoms and maintain quality of life.
Stage 3
In Stage 3 of Parkinson’s disease, individuals encounter a moderate to severe progression of symptoms that significantly impact their daily lives. This stage is marked by increased challenges in mobility and an elevated risk of falls.
Motor symptoms become more pronounced, and individuals experience a considerable decline in physical movements with an increased difficulty in performing routine tasks.
Postural instability becomes more prominent, leading to a higher risk of falls. Individuals may find it challenging to maintain balance and coordination, requiring increased attention and caution during daily activities.
At this stage, medications become more crucial in the overall Parkinson’s disease treatment plan for managing symptoms. Doctors adjust the dosage of different types of medications based on the symptoms.
Stage 4
In Stage 4 of Parkinson’s disease, individuals face a more advanced and severe progression of symptoms, leading to a significant impact on daily life and increased dependence on assistance. Daily activities that were once routine and effortless become challenging, leading to a decline in overall well-being.
Parkinson’s disease specialists opine that apart from medications, individuals may require additional support from specialised care teams, including nurses, therapists, and home care providers, to manage complex symptoms and ensure proper care.
Stage 5
Stage 5 of Parkinson’s disease, often referred to as the end stage, represents the most advanced and severe phase of the condition. Individuals in Stage 5 experience significant limitations in motor function, cognitive decline, and a substantial impact on their overall quality of life.
Immobility is a defining feature of Stage 5. Individuals may be confined to a wheelchair or bed due to the extreme difficulty or inability to stand or walk.
Given the challenges in Stage 5, a multidisciplinary approach involving healthcare professionals, caregivers, and support services is essential. Palliative care becomes an integral component of the Parkinson’s disease treatment approach at this stage to enhance comfort, manage symptoms, and provide support for individuals with Parkinson’s.
It is crucial to note here that the Hoehn & Yahr scale has been criticized for not taking into account non-motor-related symptoms of Parkinson’s disease. Additionally, many Parkinson’s disease specialists believe that the staging system fails to capture individual patient’s symptoms and is not useful for designing treatment plans. This is why scaling systems such as the MDS-Unified Parkinson’s Disease Rating Scales are used nowadays.
Treatment
It’s important to note that even though Parkinson’s disease is not curable, various treatment options are available. The treatments for Parkinson’s disease aim to improve quality of life by managing symptoms and, where possible, slowing down the progression of the disease.
Medications
Several medications are commonly used in the treatment of Parkinson’s disease to manage symptoms, particularly those related to the deficiency of dopamine in the brain.
It’s important to note that the choice of medication and the dosage depend on the individual’s symptoms, the stage of Parkinson’s disease, and other factors. The medications include:
- Dopamine inducers:Â The medicine Levodopa is a precursor to dopamine. It helps in increasing the levels of dopamine in the brain. It helps in managing the motor symptoms of Parkinson’s disease.
- Dopamine agonists: Dopamine agonists are medications that mimic the action of dopamine in the brain. They stimulate dopamine receptors and can be used as an alternative or in conjunction with other dopamine-stimulating drugs.
- MAO-B Inhibitors: MAO-B inhibitors are useful for breaking down dopamine in the brain. This is done by inhibiting the activity of monoamine oxidase-B. By reducing dopamine breakdown, these medications help increase dopamine levels and improve symptoms.
- COMT Inhibitors: They work by blocking the activity of the COMT enzyme, which is responsible for breaking down Levodopa in the brain.
- Anticholinergics: Anticholinergic medications are a class of drugs that block the effects of acetylcholine, a neurotransmitter, in the nervous system. In the context of Parkinson’s disease, anticholinergics are sometimes prescribed to manage specific motor symptoms. However, their use is generally limited due to potential side effects, especially in older individuals.
- Amantadine: Amantadine is an antiviral medication that also has mild anti-Parkinsonian effects. It may be used to improve symptoms, especially in the early stages of the disease or to address levodopa-induced dyskinesias (involuntary movements). The exact mechanism of action of amantadine in Parkinson’s disease treatment is not fully understood. However, it is believed to increase the release of dopamine from nerve endings and may also have anticholinergic effects, which can counterbalance the neurotransmitter imbalances seen in Parkinson’s.
Deep Brain Stimulation
Deep Brain Stimulation (DBS) is a surgical procedure that facilitates the implantation of electrodes for modulating abnormal brain activity and alleviating symptoms.
These electrodes are connected to a neurostimulator device, often referred to as a “brain pacemaker,” which is implanted under the skin near the collarbone.
The implanted electrodes deliver electrical impulses to the targeted areas of the brain. The electrical stimulation modulates abnormal neuronal activity and helps regulate the signalling pathways involved in motor control. It can lead to significant improvements in motor function and reduce the need for high doses of medication.
Conclusion
Parkinson’s disease treatments offer relief from the many challenges of living with the disease. With appropriate treatment plans, individuals can manage their symptoms and lead fulfilling lives. It’s important for individuals and their caregivers to work closely with a Parkinson’s disease specialist to develop a comprehensive treatment plan tailored to their specific needs.
Disclaimer:
This article has been written for information purposes only, and is not a substitute for professional medical advice by a qualified doctor or other health care professional. The author is not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by the information in this article. Always consult a qualified healthcare provider for accurate diagnosis, personalised treatment, and recommendations tailored to your individual health needs.
