Parkinson’s Stages for the Elderly: Life Expectancy and FatalityArticle by Daniel Westhead
- What is Parkinson’s disease?
- What is the main cause of Parkinson’s disease?
- Who is most likely to get Parkinson’s disease?
- What is early-onset Parkinson's disease?
- What are the first signs of Parkinson's?
- What are the 5 stages of Parkinson's disease?
- What is the life expectancy with stage 5 Parkinson’s?
- What is the cause of death for most Parkinson’s patients?
- 5 facts and figures about Parkinson’s disease
If you or an elderly loved one has been diagnosed with Parkinson's, you're probably wondering about disease stages and progression, life expectancy and fatality. It’s completely normal to feel overwhelmed at first with the abundance of information available at the click of a button.
Firstly, it's important to understand that everyone is different – some people experience changes over several decades, whereas others deteriorate more quickly. Nevertheless, being aware of the various stages of Parkinson's disease can help patients and healthcare providers make informed decisions about treatment plans.
It can also be valuable to learn about the condition’s prognosis, so we’ll share several statistics about life expectancy and fatality in this guide. Hopefully, you’ll find these figures more empowering than frightening. Many people actually feel better when they have the knowledge to plan for their future. Our top advice? Take everything with a pinch of salt – the data might not necessarily apply to your unique case.
Whatever your circumstances, we’re sure you've got a million questions. Keep reading as we explain everything you need to know, including facts and figures about the 5 stages of Parkinson's disease.
What is Parkinson’s disease?
Before we run through Parkinson's stages, let's take a closer look at the science.
Parkinson’s is a complex neurological illness that damages part of the brain called the substantia nigra – this area is largely responsible for controlling movement and dopamine production. Unfortunately, the condition is progressive, and there is no cure. However, you can manage symptoms with supportive therapies, such as physiotherapy and speech therapy, medication and surgery.
Plus, you can gain some much-needed peace of mind by investing in home help and personal alarms with fall detection. The Fall Alert pendant is a lifeline for those struggling with motor disorders, such as Parkinson’s, Huntington’s and ataxia.
We'll dive into the symptoms in more detail when we discuss Parkinson's disease stages and the early signs of Parkinson’s, but here's a quick outline of what to expect. Remember, everyone is different – you won't necessarily experience everything at the same intensity.
- Uncontrollable body tremors that usually start in the hand or arm
- Muscle stiffness that impacts movement and facial expressions
- Painful muscle cramps (dystonia)
- Slowness of movement and difficulty with balance and coordination
- Loss of smell (anosmia)
- Insomnia and extreme tiredness
- Urinary infections and constipation
- Impaired swallowing, chewing and speaking
- Depression and anxiety
- Memory loss, ranging from mild to severe (dementia is a common symptom of Parkinson's disease)
What is the main cause of Parkinson’s disease?
Experts still don't fully understand why some people develop Parkinson's, but most agree it's a combination of genetic and environmental factors.
The Parkinson's Foundation estimates around 10% to 15% of all patients have some form of genetic mutation. These genes are usually passed down throughout the generations, so having a close relative with Parkinson's may increase the chances of developing the condition. On top of this, evidence suggests ongoing exposure to pesticides and head trauma play pivotal roles.
Who is most likely to get Parkinson’s disease?
Parkinson's is the fastest-growing neurological disease in the world, and around 145,000 people in the UK live with the condition. It doesn't discriminate, and anyone can develop symptoms. With that said, there are a few key factors that increase risk.
Most people with Parkinson's are senior citizens and are over 65 years old, although thousands of working-age people also suffer. Receiving a diagnosis under 50 is called early-onset Parkinson's. While the news is devastating, catching the disease early is linked to slower progression and a more favourable survival rate.
Plus, men are more prone to Parkinson's than women. Researchers aren't sure why but guess it might be related to male-dominated professions. Head trauma and toxin exposure are more likely in careers such as contact sports and manual labour.
What is early-onset Parkinson's disease?
As mentioned, early-onset Parkinson's is when a person receives a diagnosis before the age of 50. The National Institute on Aging estimates around 10% to 15% of all cases fall into this category. Experts don't fully understand why younger people develop Parkinson's, although they cite head trauma and genetic factors.
For instance, ex-international rugby players are two and a half times more likely to develop a neurodegenerative disease and three times more likely to have Parkinson's than the general population. Ex-footballers and American footballer players have similar rates of the condition.
The good news? Early-onset Parkinson's has a better prognosis and survival rate. Medical professionals have more time to create and implement personalised treatment plans to stall progression. These might include:
- Working with a speech therapist and an occupational therapist.
- Counselling and emotional support.
- Staying as active as possible to aid mobility.
- Eating a healthy diet to boost overall wellbeing.
- Certain dopamine agonists.
- Deep brain stimulation.
Another interesting distinction is the types of symptoms a person experiences with early-onset Parkinson's experiences. Older people tend to suffer from memory loss, confusion and balance problems, whereas younger people battle rigidity and slow movement.
Ultimately, younger bodies are better equipped to withstand low dopamine levels. Plus, their brains have higher neuroplasticity – the nervous system’s ability to positively respond to injuries, such as stroke or head trauma.
The only exception is juvenile Parkinsonism, where someone is diagnosed under the age of 21. Here, the cause is often specific, high-PD risk genetic mutations. Juvenile Parkinsonism and Parkinson's share similar symptoms, including stiff muscles, tremors and poor balance. However, the former has a lower life expectancy of around 30 years.
What are the first signs of Parkinson's?
So, what are the first signs of Parkinson's? You've probably realised by now that everyone is different. Some people may notice changes in their 30s or 40s, while others don't realise they have the disease well into their twilight years. Age is a fundamental factor in what symptoms switch on and when, how well a person copes and the speed of progression.
For the purpose of this guide, we'll run through common first signs of Parkinson's for people approaching or over 60, as this is when most people receive a diagnosis. You might be surprised to learn that many early symptoms are non-motor related.
Loss of smell
Research shows that loss of smell is a reliable early symptom of Parkinson's disease, and 95% of all patients experience significant olfactory damage. Experts aren't sure exactly why this happens but have noticed that people with the condition have smaller "olfactory bulbs" – the part of the brain that processes smell.
While online resources generally focus on motor-related symptoms, loss of smell can be devastating for sufferers, affecting dietary habits, weight and mood. Many people lose interest in the things they used to enjoy, like eating out at restaurants and family meals. Unfortunately, olfactory issues don't respond to Parkinson's medication, but your GP can help you navigate the change.
Sleep disorders and insomnia are usually caused by other Parkinson's symptoms, such as restless leg syndrome and muscle stiffness. However, you might be more likely to notice disrupted sleep, especially if you're in the early stages of the disease, where motor-related issues haven’t fully developed.
The condition itself also chemically changes the brain, leading to excessive daytime sleepiness, circadian rhythm sleep disorders and REM sleep behaviour disorder. The latter is particularly distressing for patients and their partners. People physically act out vivid dreams (often nightmares) with vocal sounds and violent moments. Thankfully, there are plenty of easy ways to improve sleep quality.
Constipation and urinary tract problems
Bladder and bowel problems are common as we age but particularly prevalent in the Parkinson's population. Urge incontinence, nocturia (waking up frequently in the middle of the night to urinate) and severe constipation are some of the earliest signs of the disease. If you're struggling with your toilet habits, your doctor might suggest medication and lifestyle changes, such as a healthy diet.
Depression, anxiety and mood disorders
Finally, many people with Parkinson's notice considerable changes in their mood. Sometimes, patients develop depression and anxiety months before an official diagnosis. This is because of chemical changes in the brain and lower levels of dopamine, norepinephrine and serotonin – all crucial for regulating mood and motivation.
Understandably, these emotional disorders often become worse after receiving a diagnosis, as people wonder what their future has in store. Speak to your healthcare team about supportive therapies if you're struggling with your mental health.
What are the 5 stages of Parkinson's disease?
So, what are the 5 stages of Parkinson's disease? Although progression is impossible to predict, certain symptoms and their severity usually indicate where you are on the ladder. It's important to know this information. Not only will you feel more confident managing the condition, but you can prepare your loved ones for the journey ahead.
The stages were defined in 1967 by respected Parkinson's researchers Margaret Hoehn and Melvin Yahr. The Hoehn and Yahr scale breaks down the disease based on clinical disability, ranging from:
- Stage 1: Mild
- Stage 2: Moderate
- Stage 3: Mid-stage
- Stage 4: Advanced
- Stage 5: Palliative
Keep in mind this is a fairly typical progression of the disease for someone diagnosed later in life. The journey may look a little different for a person with early-onset Parkinson’s.
Stage 1: Mild
Stage 1 is the earliest and mildest form of Parkinson's. Individuals may experience loss of smell (anosmia), which sometimes develops several years before other symptoms. Additionally, they'll often have minor tremors on one side of their body and changes in posture and facial expressions.
Generally, people don't notice much interference in their daily lives. Although the symptoms are noticeable, they don't impact showering, dressing, and cooking.
Treatments to manage early-stage Parkinson's may include lifestyle changes, such as regular aerobic exercise, physical therapy and working with a speech-language pathologist. Some doctors may prescribe amantadine (Gocovri) to prevent sudden uncontrolled movements.
One fascinating study followed 695 patients to identify the length of progression between each of the Parkinson's stages. Researchers found it took approximately 20 months to transition between stages 1 and 2.
Stage 2: Moderate
Stage 2 is moderate, but you'll still notice a significant increase in the intensity of symptoms. Tremors and stiffness transition to both sides of the body, sometimes affecting the trunk and torso. Friends and family may be more aware of movement difficulties, such as shakiness when standing and walking.
While daily activities become a little more time-consuming, most people can still live independently. Alongside the above treatments, doctors often begin a regime of levodopa, dopamine agonists and monoamine oxidase-B inhibitors. Levodopa is the primary drug for managing Parkinson's – it boosts dopamine levels for better movement control.
Progression between stages 2 and 3 can take several months or years. As such, researchers often divide stage 2. It takes around 62 months to progress from stage 2 to 2.5 and 25 months from stage 2.5 to 3.
Stage 3: Mid-stage
Disability is mild to moderate in mid-stage Parkinson's. Loss of balance is the hallmark feature and falls become increasingly common. Many people can still complete tasks but often require extra help for more complex activities.
It's not just movement difficulties that increase the risk of falls. Parkinson's also causes low blood pressure (hypotension) when standing or changing positions. Contact your healthcare provider if you or a loved one experiences dizziness, blurred vision or fainting spells.
Progression between stages 3 and 4 takes around 24 months.
Stage 4: Advanced
The final two Parkinson's disease stages are advanced. By stage 4, symptoms are severe and disabling – individuals can no longer live independently or complete daily tasks. While they might be able to walk or stand without assistance, moving around the house or going outside presents significant challenges.
Alongside limited movement, people understandably experience emotional distress, including depression and anxiety. Plus, some suffer from hallucinations and memory loss, which intensify at stage 5. One study found that 75% of people living with Parkinson's for over 10 years develop dementia.
If you or a loved one is suffering from Parkinson’s disease dementia, you might like to consider a mobile alarm with GPS tracking and a 24/7 emergency monitoring system, especially if you aren’t living in a residential facility. The SureSafeGO 24/7 Connect is one of the most popular options, thanks to its high-tech features.
There are a few treatments to manage the advanced stages of Parkinson's, including medication and surgery. Nuplazid (Pimavanserin) prevents hallucinations and delusions. Doctors may also offer deep brain stimulation if someone isn't responding well to levodopa. Here, surgeons implant electrodes into the brain to reduce involuntary movements, tremors and rigidity.
Progression between stages 4 and 5 takes around 26 months.
Stage 5: Palliative
Finally, stage 5 Parkinson's is palliative – the only goal is to make sufferers as comfortable as possible. Usually, people are bedridden and unable to stand or walk. Carers work around the clock to help with daily activities, such as washing and eating.
Plus, patients experience speech delays and weight loss. Incontinence becomes a much greater problem, with urinary tract infections one of the most common reasons for hospital admissions.
At this point, medicines provide minimal relief. Nevertheless, healthcare providers can still create support plans that prioritise respect, privacy and emotional wellbeing.
What is the life expectancy with stage 5 Parkinson’s?
You might be surprised to learn that life expectancy for someone with stage 5 Parkinson's isn't that different from the average population. As the disease progresses over several years, many people die of other age-related complications before stage 5 or shortly after entering stage 5.
If someone reaches stage 5 Parkinson's but has no underlying health conditions, life expectancy is generally 6 to 12 months.
What is the cause of death for most Parkinson’s patients?
Most people with Parkinson's die with the condition, not from it. Cancer, heart disease and stroke are often the main culprits for premature death. Again, this is pretty similar to the general population.
However, Parkinson's does increase the risk of respiratory illnesses because patients struggle to swallow, and liquid sometimes enters the lungs. Consequently, pneumonia is the leading cause of death for those with Parkinson's disease.
5 facts and figures about Parkinson’s disease
- Genetics cause about 10% to 15% of all Parkinson's cases. The remaining 85% to 90% are classed as sporadic. (Parkinson's Foundation)
- The prevalence of Parkinson's has doubled in the past 25 years. (World Health Organisation)
- Parkinson's-related disability and death are increasing faster than any other neurological disorder. (World Health Organisation)
- The average time from the appearance of symptoms to death is between 13 to 16 years. The average age of death is 81. (American Academy of Neurology)
- Research shows that people with Parkinson's who start exercising earlier for a minimum of 2.5 hours a week experience slower symptom progression. (Parkinson's Outcomes Project)
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