Signs, Symptoms and Stages of Parkinson's

While Parkinson’s does not progress in a strictly linear fashion, many professionals use structured models—like the Hoehn and Yahr scale or a simplified three-stage model—to describe the general course of the disease.

The Five Stages of Parkinson’s Disease (Hoehn and Yahr Scale)

Stage 1 – Mild / Early Stage

• Symptoms are usually mild and affect only one side of the body (unilateral)
• Tremors, stiffness, or slow movement may begin
• Daily functioning is mostly unaffected
• Subtle changes in posture, facial expressions or walking may appear
• Symptoms may be mistaken for normal aging

Stage 2 – Mild to Moderate / Bilateral Involvement

• Symptoms affect both sides of the body (bilateral)
• Increased muscle rigidity and slowness of movement
• Walking problems or poor posture may become noticeable
• Tasks take longer, but individuals can still live independently

Stage 3 – Moderate / Mid Stage

• Postural instability becomes more noticeable
• Falls may begin to occur
• Daily activities (e.g., dressing, eating) become more difficult
• Motor symptoms are more pronounced and coordination is reduced
• Many people remain independent but may benefit from help with certain tasks

Stage 4 – Severe / Advanced Stage

• Symptoms are severe and significantly impair movement
• Individuals often require assistance with most daily activities
• Walking often requires a walker or mobility aid
• Tremors may lessen, but stiffness and slowness increase
• Cognitive changes and mood disorders may become more apparent

Stage 5 – Very Severe / Late Stage

• Individuals are typically unable to walk or stand without support
• May be bedridden or use a wheelchair full-time
• Require full-time care for all daily needs
• Speech becomes very limited; swallowing issues are common
• High risk of complications such as pneumonia or weight loss

Early Symptoms of Parkinson’s (Before Diagnosis)

Many people experience a “prodromal” phase, where subtle non-motor symptoms occur years before a Parkinson’s diagnosis:

• Loss of sense of smell
• Sleep disturbances (particularly REM Sleep Behaviour Disorder)
• Constipation
• Depression or anxiety
• Generalised fatigue
• Small handwriting (micrographia)

These symptoms may not seem related but often precede the more recognisable motor signs.

Cognitive and Behavioural Changes

Although Parkinson’s is primarily a movement disorder, cognitive and psychological symptoms can also occur, especially in later stages:

• Mild cognitive impairment (trouble with multitasking or memory)
• Parkinson’s disease dementia (PDD) – may develop in advanced stages
• Hallucinations or delusions (usually medication-induced or due to PDD)
• Mood disorders – including depression, anxiety or apathy

These symptoms require tailored care and often benefit from multidisciplinary support, including occupational therapy, psychology and speech therapy.

Young-Onset Parkinson’s

People diagnosed before the age of 50 are said to have young-onset Parkinson’s disease (YOPD).

While the motor symptoms are often similar to later-onset cases, people with YOPD may:

• Experience slower progression
• Have a higher likelihood of genetic involvement
• Face different lifestyle challenges (e.g., parenting, working, finances)

YOPD also tends to present with more dystonia (involuntary muscle contractions) and complications from long-term medication use.