In most newly diagnosed Parkinson’s patients, the anxiety revolves around the effect that the disease will have on daily functioning. However it should be noted that most Parkinson’s patients can quite comfortably manage with daily activities although there may be some level of difficulty. The symptoms in the initial stages of Parkinson’s disease may be mild, but in the last two stages of the disease or the “end stages”, the symptoms become such that the person becomes totally unable to function without help.
Stage 4 of Parkinson’s Disease
In this stage, the main difficulty is in maintaining balance and posture, so patients need assistance while standing and walking. Increase in tremor, rigidity (increased tone) and bradykinesia (slowness of movement) as the disease progresses make the performance of routine tasks difficult without help. Falls tend to occur more often. The patient is mobile at this stage but needs help to carry on with their daily tasks.
Stage 5 of Parkinson’s Disease
At this stage of the disease, the patient is unable to stand or walk and constant nursing care is needed as they cannot function independently. A number of patients also suffer from dementia, depression or hallucinations, which further aggravates the situation.
Features of the End Stages of Parkinson’s
The end stages of Parkinson’s disease can be extremely difficult and heart-breaking, both for the patient and his close relatives and friends.
- There is progressive worsening of symptoms despite of drug therapy.
- Tremor increases gradually, and in the later stages there may be action tremor (like an essential tremor) whereas initially there was tremor only at rest, thus making performance of routine tasks difficult.
- Unsteadiness in walking or turning, resulting in falls, become more pronounced as the disease progresses and ultimately the patient can only stand or walk with help, while in the end stage he becomes completely bedridden.
- Dementia and depression occur in a large number of patients of Parkinson’s disease towards the end stages of the disease and anxiety, mood changes and insomnia may be an associated symptom.
- Dysphagia or difficulty in swallowing often leads to less intake of food and nutrients, causing weight loss, weakness and tiredness.
- Constipation is often troublesome and may be a side effect of anticholinergic treatment.
- Recurrent infections occur such as pneumonia.
- Improper bladder control may lead to urgency and frequency.
- Hypersalivation or drooling is common due to difficulty in swallowing and may lead to choking.
- Memory loss – both recent and long term.
- Confusion and hallucinations become more pronounced in elderly patients being treated with anticholinergics.
- Pain and discomfort in the lower part of the body and limbs.
- There is progressive difficulty in speech with slow, soft, monotonous voice and the patient may have problem finding words.
- There may be dyspnea or difficulty in breathing.
In the end stages, the patient becomes totally helpless and cannot survive without a care-giver. They are unable to sit, talk, walk, turn around in bed, control bladder or bowel movements, or conduct any bodily function on their own. Combined with their gradually declining health status, both physical and mental, the end stage leads to death ultimately. Unfortunately, there are no medicines yet that can cure Parkinson’s disease but only help to alleviate the symptoms or delay progression of the disease.