Parkinson's Disease Research & Education Institute

Pimavanserin (Nuplazid™)has been approved by the US Food and Drug Administration (FDA) for the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis. The drug’s manufacturer, Acadia Pharmaceuticals Inc., announced the approval on April 29. Pimavanserin is the first drug indicated specifically to treat symptoms of psychosis in Parkinson’s.

PROGRESSION OF PARKINSON'S


The progression of Parkinson’s disease varies among different individuals.  Parkinson's is chronic and slowly progressive, meaning that symptoms continue and worsen over a period of years.  Parkinson's is not considered a fatal disease. And the way that it progresses is different for everyone:

Movement symptoms vary from person to person, and so does the rate at which they progress.


Some are more bothersome than others depending on what a person normally does during the day.


Some people with Parkinson's live with mild symptoms for many years, whereas others develop movement difficulties more quickly.


Nonmotor symptoms also are very individualized, and they affect most people with Parkinson's at all stages of disease.  Some people with Parkinson's find that symptoms such as depression or fatigue interfere more with daily life than do problems with movement.

Rating Scales

That said, there are tools that your doctor may use to understand the progression of your Parkinson's.  The stages of Parkinson's correspond both to the severity of movement symptoms and to how much the disease affects a person’s daily activities.  The most commonly used rating scales are focused on the motor symptoms, but new scales include information on non-motor symptoms (such as problems with sense of smell).

1. The first, known as Hoehn and Yahr, will rate your symptoms on a scale of 1 to 5.  On this scale, depending on a person’s difficulties, 1 and 2 represent early-stage, 2 and 3 mid-stage, and 4 and 5 advanced-stage Parkinson's.


2. Another scale commonly used to assess the progression of Parkinson's is the United Parkinson’s Disease Rating Scale (UPDRS).  It is more comprehensive than the Hoehn and Yahr scale, which focuses on movement symptoms.  In addition to these, the UPDRS takes into account cognitive difficulties, ability to carry out daily activities, and treatment complications.

Severity of Parkinson's

Below are some descriptions of mild, moderate and advanced Parkinson's.  As disease progresses differently in different people, many do not progress to the advanced stage. 


Mild Parkinson’s

Movement symptoms may be inconvenient, but do not affect daily activities


Movement symptoms, often tremor, occur on one side of the body


Friends may notice changes in a person’s posture, walking ability or facial expression


Parkinson's medications suppress movement symptoms effectively


Regular exercise improves and maintains mobility, flexibility, range of motion and balance, and also reduces depression and constipation

Moderate Parkinson’s

Movement symptoms occur on both sides of the body


The body moves more slowly


Trouble with balance and coordination may develop


“Freezing” episodes — when the feet feel stuck to the ground — may occur


Parkinson's medications may “wear off” between doses


Parkinson's medications may cause side effects, including dyskinesias (involuntary movements)


Regular exercise, perhaps with physical therapy, continues to be important for good mobility and balance


Occupational therapy may provide strategies for maintaining independence

Advanced Parkinson’s

Great difficulty walking; in wheelchair or bed most of the day


Not able to live alone


Assistance needed with all daily activities


Cognitive problems may be prominent, including hallucinations and delusions


Balancing the benefits of medications with their side effects becomes more challenging

At all stages of Parkinson's, effective therapies are available to ease symptoms and make it possible for people with Parkinson's to live well.