Parkinson’s disease is a progressive neurodegenerative disorder that affects movement and motor skills. As Parkinson’s advances, symptoms tend to worsen over time. Recognizing signs of progression can help patients and doctors make appropriate treatment adjustments to best manage symptoms.
Motor Symptoms
Parkinson’s disease is characterized by motor symptoms like tremor, rigidity, bradykinesia (slow movement), and postural instability. Worsening of these core motor symptoms is a clear sign that the condition is progressing.
Tremor
Tremor typically affects the hands, arms, legs, jaw, or face. As Parkinson’s advances, tremor often spreads to additional body parts and becomes more severe. Tremor at rest tends to worsen first. Tremor may also become more prominent during activities.
Rigidity
Muscle rigidity causes stiffness and resistance to movement. Increased rigidity in muscles is a sign of Parkinson’s progression. Rigidity may spread to other limbs and the neck. Simple tasks like walking, dressing, or bathing become more difficult as rigidity increases.
Bradykinesia
Bradykinesia refers to slowness of movement. As Parkinson’s progresses, people experience greater slowness and difficulty initiating voluntary movements. Activities require more time and effort as bradykinesia worsens.
Postural Instability
Impaired balance and coordination makes walking difficult and increases fall risk. Worsening balance problems indicate that Parkinson’s is advancing. Patients may be unable to correct themselves after suddenly losing balance.
Non-Motor Symptoms
In addition to motor impairments, Parkinson’s causes many non-motor symptoms that can worsen with disease progression. These include:
Cognitive Changes
Up to 50% of Parkinson’s patients experience cognitive impairment. Early signs include executive dysfunction, which makes planning, prioritizing, and decision making more difficult. As Parkinson’s advances, dementia becomes more likely. Memory problems, disorientation, and confusion signal cognitive decline.
Sleep Disturbances
Difficulty staying asleep is common in Parkinson’s. As the condition progresses, rapid eye movement sleep behavior disorder may emerge. This causes people to act out vivid dreams by yelling, thrashing, and punching.
Mood Changes
Many individuals with Parkinson’s suffer from depression and anxiety. These mood disorders tend to worsen as the disease advances. Apathy, irritability, and memory loss add to emotional difficulties.
Fatigue
Excessive tiredness and sudden “offs” of energy are common Parkinson’s symptoms. Worsening fatigue interferes with daily activities and quality of life. Some find fatigue the most disruptive symptom as Parkinson’s progresses.
Other Issues
Other non-motor symptoms that may worsen over time include urinary problems, constipation, speech changes, slowed swallowing, blurred vision, and sensory disturbances. Declining ability to perform daily living activities also signals progression.
Signs of Late-Stage Parkinson’s
In the later stages of Parkinson’s, symptoms become increasingly disabling. Recognizing end-stage Parkinson’s can help guide care planning and support needs.
Falling and Freezing
Balance impairment causes frequent falls, sometimes resulting in injury. Freezing of gait also increases, causing sudden inability to move the feet forward when walking. Falls and freezing restrict mobility and increase reliance on assistance.
Swallowing Problems
Dysphagia, or trouble swallowing, arises in the later Parkinson’s stages. Difficulty eating and drinking can lead to choking, malnutrition, and aspiration pneumonia.
Speech Changes
Slurred, monotonous, quiet speech develops due to motor control problems. Advanced Parkinson’s greatly limits effective communication abilities.
Cognitive Impairment
Severe cognitive decline including dementia and psychosis occur in late-stage Parkinson’s. Memory loss, confusion, hallucinations, and delusions require full-time supervision for safety.
Care Dependency
Progressive loss of independence means relying on others for assistance with personal care, cooking, and household tasks. Professional caregiving or placement in a specialized Parkinson’s residence may become necessary.
Tracking Parkinson’s Progression
Monitoring changes in symptoms and function over time helps evaluate how quickly Parkinson’s is advancing. This allows doctors to make appropriate medication and treatment adjustments. Methods for tracking progression include:
Symptom Journals
Keeping a daily journal of motor and non-motor Parkinson’s symptoms can identify worsening issues. Note symptom severity, how symptoms impact function, and response to medications.
Rating Scales
Validated rating scales that assess motor impairment, disability, and quality of life provide standardized measures of Parkinson’s progression. The UPDRS and Hoehn and Yahr scale are commonly used.
Neurological Exams
During office visits, neurologists perform examinations to evaluate changes in movement, coordination, balance, rigidity, and more. Comparing current and past exams reveals progression.
Home Safety Assessment
Occupational therapists can assess the home environment and recommend modifications to support greater safety and independence as Parkinson’s advances.
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When to Seek Medical Attention
Consult your neurologist right away if you experience:
- Sudden worsening of current Parkinson’s symptoms
- Rapid progression of symptoms
- New symptoms like swallowing problems or cognitive decline
- Falls, especially with injury
- Significant medication side effects
- Freezing that causes immobility
Emergency care is needed for choking, aspiration pneumonia, or psychosis. Ongoing communication with your Parkinson’s care team is key to appropriate symptom management as the disease runs its course.
Treatment Options for Worsening Parkinson’s
Steps to take when Parkinson’s symptoms progress include:
Medication Adjustments
Your neurologist can adjust dosages, change medications, or add new ones to improve control of motor and non-motor symptoms.
Advanced Therapies
Treatment options like deep brain stimulation or continuous medication pumps may be considered for eligible candidates whose symptoms no longer respond sufficiently to oral medications.
Physical, Occupational, and Speech Therapy
Working with therapists can maximize mobility, independence, safety, and quality of life as Parkinson’s advances.
Lifestyle Changes
Exercise, sleep hygiene, stress management, and healthy nutrition support overall wellbeing. Assistive equipment and home modifications can also help.
Support Services
In the later Parkinson’s stages, community services, home healthcare, adult day programs, or residential care may provide needed support.
Prognosis of Worsening Parkinson’s
Parkinson’s is a progressive disease without a cure. Symptoms grow worse over time, but the rate of progression varies:
- Younger onset progresses slower
- Older onset progresses faster
- Men tend to have a more rapid course
- Significant progression can occur in as little as 2 years in some patients
- Others experience a more gradual decline over 20 years or more
Overall, life expectancy with Parkinson’s is slightly reduced. However, many people live 10-20 productive years after diagnosis before reaching the later stages. While Parkinson’s itself is not fatal, complications like aspiration pneumonia can be in end-stage disease.
Coping with Parkinson’s Progression
Adapting to worsening Parkinson’s presents many physical and emotional challenges. Tips for coping include:
- Learn about disease stages and prognosis
- Join a Parkinson’s support group
- Enlist family and friends to help
- Focus on remaining capabilities
- Practice daily relaxation techniques
- Focus on one day at a time
- Find enjoyable hobbies you can still do
- Tap into spirituality or faith practices
- Consider counseling for depression or anxiety
- Communicate openly with your care team
Conclusion
Parkinson’s disease is a progressive neurodegenerative disorder without a cure. Monitoring worsening symptoms and regularly consulting your neurologist allows the best opportunity to manage symptoms and maintain quality of life. While the later stages of Parkinson’s bring profound disability, many people live actively with their diagnosis for years before reaching this point. With proper treatment and support, life can still be fulfilling despite Parkinson’s progression.