The Stages of Parkinson's Disease

Drawing by Jean-Martin Charcot of a Parkinson's disease patient in Morocco (Photo credit: Wikipedia)

Parkinson's Disease can affect 1 in 300 people according to Parkinson's.org. Can you believe that? I didn't even know that there were that many people out there living with Parkinson's. And it was not really a disease that I dealt with that much in my nursing career. Parkinson's disease has been around for a very long time. There is no cure. It can be treated. The symptoms often start in the late 50-60's and can devastate a patient and their family. Usually people with Parkinson's progress through 5 stages.

• Stage One-Tremors are usually the most notable early symptom of the disease. Usually the tremors are unilateral  meaning they occur on only one side of the body. Pill rolling, or a rubbing movement between the thumb and the forefinger, is often present. AT this time you might notice postural changes, becoming slightly stooped at the waist, facial changes; the rigid mask of not smiling or frowning, or problems with balance. In my husband's case, the early sign was that I noticed he was no longer swinging both arms when he walked. That is the NORMAL way of walking. He only swung one arm. That is often the first sign noticed. I remember this from nursing school, so we made an appointment with the neurologist. He also had the pill-rolling early on. Very little other symptoms appeared in him at this time.
• Stage Two-Usually entering stage two means that both sides of the body becomes affected. They also start to experience a slowing of their movements. Sometimes they can experience what is called "freezing". This is where their body simply refuses to move. It is like their feet are stuck to the floor. They start to shuffle when they walk. I think out of all of the symptoms of Parkinson's  besides the shaking, people will notice the shuffle. After we received the diagnosis we quickly advanced to the stage two. His posture started to become slightly stooped and he began to shuffle. Also at this time we noticed the mouth involvement. He would smack his lips and have a constant chewing motion. It was due to this that his doctor started him on Parkinson's medications. However, he did not like to take them. They made him nauseated. No matter when or how he took them. And the mouth movement really bothered me more than him. So his doctor told him to only take the meds when things bothered "HIM". 
• Stage Three-Our doctor told us that stage 3 is considered the 'moderate stage of Parkinson's. Ha! Body movements will slow. They will have a harder time walking straight. They will be more bent over. Sometimes they list from side to side. The tremors may become worse. Their speech will start to soften. And be more monotone. Everything slows! Digestion slowing might make for more problems with constipation. They might suffer with insomnia. Richard does and has taken sleeping pills for years due to his inability to sleep. Part of the problems comes with not being able to move himself in the bed. Cannot turn from side to side without help. 
• Stage Four-This stage usually has the severe symptoms. They might still be walking, but to a very limited extent. This is the advanced stage of Parkinson's. The stiffness of their body increases. Surprisingly though at this stage often the tremors go away. That is what happened with Richard. He just no longer has any of the tremors. He does still shuffle and he has 'freezing' episodes. But NO more tremors. Most patients in the fourth stage of Parkinson's can no longer live alone. They will need plenty of help with their activities of daily living: walking, eating, dressing. Just generally in taking care of themselves. It was at this stage that Richard had a stroke. So it is really hard to tell which of the symptoms he has comes from the stroke and which are because of Parkinson's. He has more trouble eating, chewing, swallowing. And he Coughs! Especially will eating. Weakened muscles make both chewing and swallowing harder. Coughing while eating can cause aspiration pneumonia. While he was in the hospital they insisted on pureed food. We just cut it up pretty small at home. 
• Stage Five-The Final stages of Parkinson's Disease. Some patients become complete invalids at this point and need continuous and constant nursing care. The disease fully takes over their body. Many of them quit communicating all together. The are extremely stiff and rigid  They do not assist at all with movements or dressing. The usually need to be fed. Most become incontinent (lose control of bowels and bladder) It is like the vitality of their body has been completely sucked out of them.

We are currently in the fourth to fifth stages of Parkinson's. The doctor says that it is the end-stage. He no longer is able to walk, yet he can still stand and help with transfers. He can still feed himself if I set it all up for him. He is totally dependent upon me to dress him, bathe him, assist him on the commode. His speech is very soft and sometimes slurred. He does not initiate conversations, but he does still participate in conversations. 

He is showing some of the signs of dementia. He is often confused to date and time of day. So far, he does not have hallucinations. So far, he knows all of his family. He sleeps a lot in the daytime. He is depressed. And sometimes anxious. He has problems with dandruff and constipation. Part of the disease process. There is no cure. It is progressive. It is not fair! But it is what we deal with every day of the week and every hour of the day.