5 Early Signs of Parkinson’s Disease + Next Steps

What is Parkinson’s?

Parkinson’s disease is a neurodegenerative disorder. Loss of dopamine-producing brain cells leads to progressive degeneration of motor function.

The precise cause of Parkinson’s is unknown, although researchers believe that both environmental effects and specific genes may be involved. The average age of a Parkinson’s diagnosis is 56, but with advancing technology, diagnoses are being made earlier and earlier.

Knowing the signs to watch for can help you address suspicions of Parkinson’s in a loved one at its earliest stages, allowing for early testing to confirm a diagnosis.

While a cure hasn’t been found yet, the symptoms of Parkinson’s can be treated, minimizing their effects on daily activities as well as mental & emotional health.

The Five Stages of Parkinson’s Disease

There are five recognized stages of Parkinson’s disease, known as the Hoehn and Yahr Scale. Physicians throughout the world use the Hoehn and Yahr Scale to classify patients’ progression.

Each stage represents an advancement in symptoms as the disease worsens. Persons in stage four, however, can conceivably have their life impacted more negatively than a person in stage five due to the full range of symptoms and levels of severity within each stage. Some patients never reach stage five.

Stage One of Parkinson’s Disease

In stage one of Parkinson’s disease, symptoms can be very mild and almost unnoticeable. Parkinson’s is often misdiagnosed as a small stroke suffered by the patient.

Similar to how a stroke presents, Parkinson’s disease symptoms typically start on one side of the body (unilaterally), causing very slight problems. In a majority of cases, patients in stage one don’t seek medical treatment, instead attributing their symptoms to overall aging. 

Stage One Symptoms Include: 5 Very Early Signs of Parkinson’s Disease

The five most initial symptoms to show up are generally so mild they don’t affect day-to-day life. They include slight changes in

• Posture: most commonly a slight stoop
• Walking patterns: typically an almost indiscernible dragging of one foot
• Balance: primarily upon standing suddenly
• Facial expression: causing one side of the face to sag or twitch
• Sense of smell: a loss in smell perception, leading to overcooking (or even) burning food or failing to notice/ clean up a mess.

A tremor is typically a symptom that shows up later, but early-stage Parkinson’s patients who display other signs may also present a slight tremor, almost always affecting one side at first. As this can be subtle, your loved one may not say they’re experiencing a tremor; instead, comment that they’re feeling clumsy and slow when they move.

Stage Two of Parkinson’s Disease

In stage two of Parkinson’s disease, impairment begins to become apparent. Because of its very slight presentation, many patients’ symptoms are often misdiagnosed with age-related weakness.

Stage two is still considered an early stage of the disease and can develop months or years after stage one makes an initial appearance. 

Stage Two Symptoms Include Mild But Escalating Parkinson’s Symptoms.

1. The same symptoms as stage one, extending to both sides of the body (bilateral involvement)
2. Decreased blinking of the eyes
3. A soft or monotone voice, or one that starts off loud and fades in volume
4. Speech dysfunction (slurred or unclear speech) 
5. Stiffness or rigidity of the trunk muscles, causing neck or back pain
6. Stooped posture
7. Slowed activity

Tremor may still be absent, making an accurate diagnosis difficult. In stage two of Parkinson’s disease, your loved one is generally still able to perform daily tasks, like bathing, dressing, and cooking, but these processes may take longer than before. 

Stage Three of Parkinson’s Disease

Stage three of Parkinson’s disease is considered “mid-stage.” Diagnosis is typically no longer in doubt, with the tell-tale tremor evident. Other symptoms will also be present. Personal tasks like dressing, personal hygiene, and eating can still be performed independently; it can take a significant amount of time to achieve any of these tasks.

Stage Three Symptoms Include The Four Cardinal Signs of Parkinson’s

• Significant loss of balance (falls, especially straight back, are common at this stage)
• Significantly slowed movement 
• Stiffness and pain in the trunk and limbs
• Severe and noticeable tremor

Speech issues and facial tics may continue to worsen during stage three of Parkinson’s. Everyday activities and tasks can be very challenging now. Your mom or dad’s ability to successfully still live on their own is another good indicator they are still in stage three and have not yet reached stage four.

Stage Four of Parkinson’s Disease 

In stage four of Parkinson’s disease, your loved one will be experiencing a severe disability and will no longer be capable of living alone without significant on-site help. At stage four, Parkinson’s is considered to have progressed to a ‘severely disabling’ disease. 

Stage Four Symptoms Include Distinct Disability.

Once your loved one has reached stage four, it is time to discuss moving into a senior center with assistance for residents who require it. Patients with stage four Parkinson’s may:

• Be able to walk and stand without added supports or assistance but still be severely incapacitated
• Use a walker to help stabilize themselves
• Need help with basic daily acts, such as hygiene, dressing, and eating
• Shake uncontrollably and require living area safety measures to reduce the risk of falling

The necessity for help with daily living is what defines stage four of Parkinson’s (one’s ability to live alone is a defining characteristic of stage three). 

In stage four, tremors can be extremely significant even if other symptoms are slow to appear. Untreated, tremors alone can preclude living alone.  

Stage Five of Parkinson’s Disease

In stage five of Parkinson’s disease, all symptoms reach a peak requiring round-the-clock assistance. Not all patients reach stage five before passing quietly from unrelated causes.  

Stage Five Symptoms Include Complete Disability.

In addition to being completely incapable of essential self-care, patients who reach stage five may also:

• Be unable to rise from a bed, chair, or other seated position without help
• Have a tendency to fall when standing or turning
• Freeze or stumble when walking
• Fall frequently
• Have hallucinations or delusions 

Constant assistance is required at this stage to reduce the risk of falling and assist the patient with all daily activities. 

By recognizing the early signs of Parkinson’s, you can get the right care for your loved one as soon as possible and begin the process of managing their symptoms with medication or other interventions. Once the last stages of the disease are reached, residential placement in a safe, caring community is often the best option.