Parkinson's disease (PD) affects about 1 in every 100 people over the age of 60. According to the National Institute of Neurological Disorders and Stroke of the National Institutes of Health, as many as 500,000 Americans may have the disease. Although Parkinson's is not a fatal disease in itself, it can be quite disabling in its later stages, and death is frequently due to the resulting complications, including pneumonia or falls. Treatment has improved significantly in the last few decades, allowing sufferers an increased life span and improved quality of life. Still, no cure has yet been found.
Determining PD Stages
Not everyone with PD will experience the same symptoms to the same degree, so the disabling features vary among the population, as does the course of the disease. Because its advance is so unpredictable, several systems have been designed to illustrate the progress of the disease for the individual person. All of these systems function in the same basic manner: Assessments of the PD patient's symptoms are made on a regular basis and then compared with previous assessments.
Hoehn and Yahr Staging of Parkinson's Disease
A common scale used to describe the progression of Parkinson's, the Hoehn and Yahr Parkinson's Staging scale, includes five stages. The first describes early signs of the disease: mild symptoms found on one side of the body only. By the fourth stage, those with PD can still stand or walk very short distances without too much help, but their trunks and limbs are more rigid and all movements are very slow. It is especially difficult to initiate movement. At the last or fifth stage on this scale, the person can no longer walk. She is either wheelchair or bedbound and is basically a complete invalid.
Unified Parkinson's Disease Rating Scale (UPDRS)
Another, more complex, rating scale that may be used to express the progression of Parkinson's, the Unified Parkinson's Disease Rating Scale consists of three sections: mental functioning, behavior and mood; activities of daily living; and motor function. The questions in each section are rated from 0 to 4, with the higher number indicating more pronounced symptoms. The highest score is 199. This test is generally administered via an interview by a health care provider.
Among the symptoms rating highest on this list---and thus found at the last stages of PD---are: severe memory loss, hallucinations, insomnia and anorexia, loss of interest in life; unintelligible speech and drooling, illegible handwriting, inability to dress or feed oneself; requiring assistance for personal hygiene and mobility---even just turning over in bed, marked tremor and pain; facial expressions are flat or the person may appear to be staring; the neck, limbs and trunk are rigid; cannot sit or stand upright, needs help to get to standing and cannot remain standing without assistance; is unable to walk, and any movement that the person can manage is done very slowly.
Schwab and England Activities of Daily Living
A third scale described on the National Parkinson Foundation Website, the Schwab and England Activities of Daily Living Scale, looks at how the PD patient functions and has either the patient or his health care provider rate those abilities to come up with a scale ranging from 100 to 0 percent, with the lower number indicating greater disability.
At 20 percent on this scale, the person is not able to independently or carry out any of the usual activities of daily living, including eating, dressing, hygiene or walking, though the person may be able to help with a few of these chores. At 10 percent, the person is totally dependent, and at zero percent, the person is bedridden and unable to swallow or control his or her bladder or bowels.
