Advanced Parkinson’s may develop after many years, but for some, it can progress more quickly.

Neurologists often use the Hoehn and Yahr scale to track how Parkinson’s progresses over time.

In general, a higher stage number reflects more advanced disease. People in later stages tend to experience more movement-related disability and may need more support with daily tasks than those in earlier stages.

Stage 1

In this early stage of Parkinson’s disease, symptoms are typically mild and don’t interfere much with daily activities. Tremor, stiffness, and bradykinesia usually affect only one side of the body.

In addition, a person with stage 1 Parkinson’s may also have movement symptoms such as:

• Reduced arm or leg movement while walking
• Less facial expression (sometimes called facial masking)

Stage 2

During stage 2, Parkinson’s symptoms often become more noticeable and begin to affect both sides of the body. A person may experience changes in gait (walking), posture, facial expression, and voice.

People in this stage can usually continue living independently, but daily activities like getting dressed or cooking may take longer and require more effort.

Stage 3

At stage 3, balance problems and bradykinesia are more pronounced. People in this stage may need to be especially careful when walking or turning to prevent falls.

Most individuals can still manage their daily routines on their own. However, everyday tasks like getting dressed, bathing, or making meals may take longer and be more difficult.

Stage 4

Stage 4 marks the beginning of advanced-stage Parkinson’s. At this point, symptoms are more severe and limiting. Many people need a walker or other mobility aid to move safely.

In addition, those in stage 4 typically need help with the activities of daily living, like bathing, dressing, or managing household chores. They may benefit from support from a caregiver or care partner to maintain their safety and quality of life.

Stage 5

Stage 5 is the most advanced stage of neurological dysfunction in Parkinson’s disease. Severe muscle stiffness and limited mobility can make it difficult to stand and walk. Many people in this stage require a wheelchair or may be confined to bed.

Around-the-clock care is usually needed to assist with all daily activities. Nonmotor symptoms, like hallucinations or delusions, can also happen and may make care more complicated.

Other Parkinson’s Tracking Tools

Some neurologists also use the Unified Parkinson’s Disease Rating Scale (UPDRS) to track symptoms. The UPDRS looks at several factors, including nonmotor experiences in daily life. This scale looks more at what Parkinson’s is like for people day to day, not just whether they can do certain tasks.

Members of MyParkinsonsTeam have discussed a wide range of experiences with Parkinson’s progression. “I was diagnosed with PD in 2003, and my symptoms did not advance significantly until 2019,” one member wrote.

Another said, “My PD has advanced slowly, and I feel pretty good most of the time.”

Understanding how Parkinson’s can progress and the tools doctors use to track it can help you and your care team plan ahead, make informed decisions, and feel more prepared for what’s next.

Navigating Advanced Parkinson’s Disease

People with advanced-stage Parkinson’s may experience more than neurological dysfunction. They can also face complications related to medication effectiveness and movement disorders.

When Medication Stops Working

People with advanced Parkinson’s disease have likely been taking their medications for many years. This means they are at risk of experiencing a wearing-off effect — when symptoms return before the next dose is due.

When someone with advanced Parkinson’s no longer responds well to medications taken by mouth, their doctor may recommend injectable or infused medications to manage the symptoms.

Parkinson’s research suggests this can happen for several reasons:

• Loss of brain cells — As Parkinson’s progresses, the brain has fewer cells that produce dopamine, the neurotransmitter involved in Parkinson’s disease. This means it also stores and processes less of the medication, causing the effects to wear off more quickly.
• Delayed gastric emptying — Slower digestion, a common symptom of Parkinson’s, can reduce how quickly and effectively the body absorbs medication.

When someone with advanced Parkinson’s disease no longer responds well to oral medications (those taken by mouth), their healthcare provider may recommend injectable or infused medications to better manage their symptoms.

Living With Dyskinesia

Long-term use of levodopa, a standard treatment for motor symptoms, can sometimes lead to dyskinesia (uncontrolled, involuntary movements).

This uncontrolled movement disorder can:

• Affect one area or the entire body
• Cause swaying, writhing, or fidgeting movements
• Occur even when other symptoms (like tremor or stiffness) are controlled
• Become more noticeable during emotional stress or excitement
• Be painful and interfere with daily living

Long-term use of the drug levodopa, used to treat Parkinson’s motor symptoms, may lead to a movement disorder called dyskinesia.

There are several treatment options for dyskinesia in advanced Parkinson’s disease, including:

• Altering the dose or timing of levodopa — This can help provide an effective dose without as many side effects.
• Changing to a different medication — If levodopa is causing dyskinesia, your doctor might recommend switching to a different formulation or changing your medication completely.
• Adding a medication that can help manage off periods or dyskinesia, as advised by your doctor.

Join the Conversation

On MyParkinsonsTeam, people share their experiences with Parkinson’s disease, get advice, and find support from others who understand.

How has Parkinson’s changed over time for you or someone you love? Let others know in the comments below.