Parkinson’s Disease Stages and Progression, Explained

If you or someone you know has been diagnosed with Parkinson’s disease, it’s natural to have a lot of questions about the future. Most people living with Parkinson’s want to know how the disease is going to change their bodies and lives as it progresses (worsens). And these questions can be as hard to ask as they are to answer. Parkinson’s symptoms can look very different from person to person. 

Experts have defined five stages of Parkinson’s disease. These stages help people understand the typical progression of this disease.

What are the stages of Parkinson’s disease?

The five stages of Parkinson’s are called the Hoehn and Yahr stages. The stages describe the movement (motor) symptoms. But they don’t address the other symptoms, like constipation and sleep disturbances. These may occur years before the movement symptoms. Additional symptoms — like memory problems and hallucinations — tend to occur in the later stages. 

Keep in mind that not everyone experiences all the stages. And each stage can be different for each person. These stages are a general guide of what to expect as the condition progresses. 

Let’s look at the five Parkinson’s disease stages. 

Stage 1

In the earliest stage, Parkinson’s affects only one side of the body. So, someone may notice that one side is more rigid. They may also notice a tremor in one hand, arm, or leg. Parkinson’s may also affect facial features on one side, which can look flat and expressionless. 

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It can be hard to notice and pinpoint the cause of early symptoms. There’s no specific test that can diagnose Parkinson’s disease. It's a “clinical diagnosis,” meaning that a healthcare professional — often a neurologist — will do a physical exam and review your symptoms. 

Symptoms during the first stage generally don’t prevent someone from doing their usual activities.

Stage 2

As Parkinson’s worsens, the symptoms begin to affect both sides of the body. These symptoms may include:

• Rigidity

• Temor

• Slow gait

• Difficulty swallowing or speaking

In this stage, most people are still able to function on their own. The symptoms don’t restrict day-to-day activities. But certain tasks will take longer and be more difficult to complete. 

Stage 3

As the condition approaches the middle stage, problems with balance may begin. While not yet severe, there’s an increased risk of falling. The hallmarks of the third stage are trouble maintaining balance and slowness of movement. 

Most people can still function on their own. But, as in stage two, activities may take more time and effort. 

To avoid trips and falls, this is an important time to make sure the living space is safe. Consider doing a home fall risk assessment. And follow tips on how to prevent falls in and out of the home.

Stage 4

In this stage, the difficulty with balance and walking becomes more severe. So, people in this stage usually need to use a walking aid, such as a cane or walker. 

People in this stage may still be able to perform some tasks by themselves. But someone with stage 4 Parkinson’s won’t be able to live alone. They’ll likely need help with some of their daily activities, like eating, bathing, and using the bathroom. 

Stage 5

Someone in the last stage of Parkinson’s is no longer able to walk. They either use a wheelchair, or they’re bedbound. This also means they’ll need full assistance with most activities of daily living. 

How long does it take for Parkinson’s disease to progress?

The progression of Parkinson’s varies. It can range from a few years to several decades. This partly depends on when the first symptoms begin. For example, in people who develop it before age 50, the symptoms often take a long time to progress — 20 years or longer. This is sometimes called young onset Parkinson’s disease (YOPD). 

If the condition develops later in life (after age 50), it may progress more quickly. But it still often takes years to reach the later stages.

The subtype of Parkinson’s can also affect how it progresses. For example, people who mostly have movement symptoms may experience a slower progression. But people who have a combination of severe movement and non-movement symptoms from the start may not respond to medications as well. And the condition may worsen faster in these people. 

Overall, many factors can contribute to how fast Parkinson’s progresses. So, it’s difficult to predict for each person.

How do you know when Parkinson’s is getting worse?

Parkinson’s disease progresses slowly. People can live for many years with good function and independence. But, as the condition worsens, it’ll be more challenging for someone to care for themself without help. These changes take a long time and aren’t noticeable right away.

People can usually manage the initial symptoms with medications. Over time, the medications — such as Levodopa — may become less effective and need adjustments. Medications may also lead to side effects of their own, like sudden spontaneous movements (dyskinesias). So, it’s important to work closely with your care team to find the right dose and treatments.

Gregg Hummer, who was diagnosed with Parkinson’s in 2019, talked with GoodRx about his experience taking Levodopa. Hummer said he can tell it’s time to adjust his medication when his balance worsens and tremors increase.

Other therapies for Parkinson’s can also help with worsening symptoms. These include: 

• Physical therapy

• Occupational therapy

• Exercise

• Deep brain stimulation, a procedure that can be really helpful for some people

But, even with the right treatment, someone with Parkinson’s will eventually start to notice how everyday tasks can start to take longer. 

What do the end stages of Parkinson's look like?

The end stages of Parkinson’s disease severely affect movement. Symptoms related to movement include:

• Difficulty walking

• Balance problems, including an increased risk of falls, especially for those over age 70

• Stiffness in limbs, making it difficult to stand or get up without help

Over time, a person will need a wheelchair or be unable to leave bed. 

Non-movement symptoms may also become more apparent. This can include: 

• Hallucinations

• Worsening memory

• Orthostatic hypotension (decreased blood pressure when standing), which can lead to dizziness and increase the risk of falls

In the most advanced form of Parkinson's, a person will be fully dependent on a caregiver around the clock. This care includes help with:

• Bathing

• Dressing

• Eating and drinking

• Using the bathroom

And, in this stage, the person won’t be able to walk, even with a walker.

Is Parkinson’s fatal, and what’s the prognosis like?

Parkinson’s disease isn’t fatal in itself, but there’s no cure. And because the progression can take years to decades, many people live a normal life span.

People often live for years with Parkinson’s before they consult a healthcare professional. While diagnosing Parkinson’s can take time, it’s never too early to reach out for help. There are treatments that can lessen symptoms and help prevent more serious complications. 

Problems associated with the condition may lead to deadly complications. This includes:

• Increased risk for infections

• Malnourishment (not getting enough essential nutrients)

• Electrolyte imbalances

• Injuries from falls

Any condition that leads to a general decline in functioning can make someone more frail and likely to have other medical conditions.

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Written by:

Joanna Jan, MD

Joanna Jan, MD, is board-certified in internal medicine and licensed to practice medicine in the state of Pennsylvania. In 2017, she received her board certification from the American Board of Internal Medicine.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician in a variety of clinical settings. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

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