Understanding the Stages of Parkinson’s Disease

Understanding the Stages of Parkinson’s Disease

In the 1980s, actor Michael J. Fox was on top of the world. He was the breakout star of the successful television show Family Ties as well as the lead character in the blockbuster Back to the Future films. His face was on lunchboxes, teen idol magazines, and every tabloid at the checkout line. But he wasn’t just a pretty face! The actor racked up one award after another, including Emmys and Golden Globes.

But there was a concern lurking behind that carefree smile. His body was starting to do strange things – his shoulder had a soreness that wouldn’t go away, and his little finger kept twitching. These issues were especially worrisome for someone so young.

In 1991, he learned the reason: he was diagnosed with Parkinson’s disease. He was only 29 years old.

In the years that followed, he worked to control the symptoms. But by 1998, he could no longer hide what was happening to him, so he went public with his diagnosis. The outpouring of love and support was just as massive as the fandom that had greeted him as young movie star.

Today, the popular actor is 62 years old. He’s been an open and eager advocate for Parkinson’s research, offering up his own experiences in an effort to educate others with the disease. In honor of his birthday this month, let’s take a look at Parkinson’s to understand the stages of the disease.

The Basics of Parkinson’s Disease

Parkinson’s Disease is a brain disorder. It usually starts out so gradually that for many years, you might have mild symptoms but not realize what’s happening to you. The disease causes uncontrollable and involuntary movements, including shaking or trembling and stiffness in various parts of the body. Your movements might be very slow, even as you consciously try to speed them up. Your motor control is deeply affected, leading to problems with balance and coordination.

Over time, you begin to have trouble with walking and talking. Other problems start to pop up, including mental and behavioral changes, such as memory difficulties or depression. You might have sleep problems and feel very fatigued. You might notice issues such as irregular blood pressure or trouble with digestion. Your ability to do things such as button up a shirt or use a kitchen knife, diminish or become unsafe.

And unfortunately, your risk of falls goes up dramatically. In fact, Michael J. Fox pointed this out in a recent interview with Variety.1

“I broke this shoulder — had it replaced. I broke this elbow. I broke this hand. I had an infection that almost cost me this finger. I broke my face. I broke this humerus,” he said.

Bone fractures are an unfortunate side effect of the regular falls that those with Parkinson’s often endure.  A medical alert system with fall detection can provide the peace of mind for those with Parkinson’s, that if a fall does happen, the medical alert technology can connect to a live agent in a 24/7 monitoring center without any need to press a button at all.

Why Does Parkinson’s Happen?

There’s no way to predict who might develop Parkinson’s. Scientists know that it results from the death of neurons in the basal ganglia, the area of the brain that controls movement.

The neurons that remain are impaired and produce less dopamine. Dopamine is a natural brain chemical. As the dopamine decreases, many symptoms result, including the hallmark movement difficulties of Parkinson’s.

In addition, those with Parkinson’s also lose some nerve endings. These nerve endings produce norepinephrine, which is a chemical that helps signals travel through the sympathetic nervous system. This nervous system controls many bodily functions, such as your blood pressure.

And finally, many of those with Parkinson’s also have Lewy bodies in their brains. These are unusual clumps of alpha-synuclein proteins, which are strongly related to dementia.

It seems that more men have Parkinson’s than women do. Most people who have Parkinson’s develop the disease after the age of 60, but up to 10% can experience early-onset Parkinson’s, like Fox did.

Genetics probably plays a role in Parkinson’s; however, the disease doesn’t seem to run in families, so the genetic problems that cause it could be triggered by environmental factors, such as being exposed to certain toxins.

The 5 Stages and Progression of Parkinson’s

How quickly Parkinson’s progresses depends on the individual. The earliest symptoms are often so gradual that you don’t realize what’s happening; the later symptoms can move so quickly that you skip right over a certain stage of the disease.

According to the Parkinson’s Foundation, here is how the five stages usually present:

Stage One

This might be so subtle that you chalk it up to something else. Maybe you tripped and fell because you weren’t paying attention and didn’t see the curb. Perhaps your hand was shaking because you were tired. Or maybe you had trouble getting out of your chair because you overdid it with exercise the day before. All of these are reasonable explanations for minor difficulties.

But over time, you begin to notice other problems. Your handwriting gets slower. Your voice gets softer. Your legs and arms aren’t moving normally. And a personal alarm button is in order because falling is becoming more frequent.

As tremors or stiffness get worse, you’ll notice that it happens on only one side of your body. You might have changes in your posture (usually pitching forward a bit to steady yourself as you walk), as well as issues with walking that often lead to falls. Friends and family might notice that you don’t make the same facial expressions that you used to. Your face might be less animated.

Stage Two

During this stage, things are getting a bit worse. You are still getting around on your own, but now you probably know that something is not quite right. The movement symptoms happen more frequently, and now they are on both sides of the body. You might also notice movements where you didn’t before, such as your torso or your neck. Your posture gets worse as you try to compensate for the difficulty in walking and keeping your balance.

You’ll find that the things you used to do with ease now take more time. Doing fine work with your hands, such as embroidery, might become almost impossible.

You might also notice other problems that are becoming more troublesome, such as issues with memory and concentration or restless legs syndrome.  

This is the stage where your doctor might suspect that Parkinson’s is causing the trouble.

Stage Three

At this point, your sense of balance is diminishing rapidly. The unsteadiness is apparent, especially if something disrupts your motion. For instance, if a child runs up and hugs your legs, that can be enough to send you tumbling to the ground. Fine motor skills were already affected; now it’s the gross motor skills that start to show the symptoms.

You can still live an independent life and thrive in your own home. You might need some assistance for more difficult things, such as moving furniture. You might need a walker or other assistive device to help prevent the falls that are becoming increasingly common. It’s a very good idea to wear a medical alert bracelet or wristband so you can reach out for help right away if you fall down or suffer any sort of accident.

Stage Four

Your symptoms at this point are very clear, constant, and disabling. You might still be able to walk or stand with the help of an assistive device of some kind, and you can likely get around without the assistance of another person as long as you move slowly and carefully.

The activities of daily living become nearly impossible or even dangerous. For instance, the unpredictability of the movements means that you probably should not be cooking dinner over a hot stove.

In recent interviews with Fox, it appears that the actor is currently in this stage of Parkinson’s. While he can still talk, do some things for himself, and get around well enough to make public appearances, he is very prone to falls and needs help on a daily basis.

Stage Five

This is also known as the end stage of Parkinson’s. At this point, the involuntary movements and other symptoms have impacted your health such that you might not be able to walk or stand at all. You need a caregiver around the clock to help you with everything. You might even need a feeding tube or other interventions to provide you with the best quality of life possible.

Treatments for Parkinson’s

There is no cure for Parkinson’s – yet. The Michael J. Fox Foundation for Parkinson’s Research is at the forefront of finding treatments and cures for this debilitating disease, raising over 1.5 billion dollars thus far in pursuit of that goal.

Medications for Parkinson’s actually help doctors make a diagnosis. That’s because if the medications work to ease the symptoms, then the doctors can rule out other problems that might be causing the involuntary movements and other issues. Some medications, like levodopa, often get a great response in the early stages of the disease. For some individuals, these medications can work very well for years. There is a wide variety of them, so your doctor can try out different options over time to find the ones that work well for you.

But there are also other options, such as physical therapy, that can help ease the symptoms to live independently for much longer. The Mayo Clinic points out that a speech-language pathologist can help with language and swallowing issues. Regular aerobic exercise can strengthen your body. Anything that focuses on balance and stretching is important.2

In advanced stages, surgery that provides deep brain stimulation might be helpful in controlling symptoms. MRI-guided focused ultrasound is also an option for those with advanced Parkinson’s that has become resistant to medications.

As Michael J. Fox has proven over the years, it’s possible to live a full and vibrant life with Parkinson’s disease. If you get the diagnosis, work closely with your doctor to find the medications that are right for you.

And on tougher days, take a bit of Fox’s advice, “Acceptance doesn't mean resignation; it means understanding that something is what it is and that there's got to be a way through it.”