Contact Information

Parkinson's Disease and Movement Disorders Center

Wang Ambulatory Care Center
15 Parkman Street
8th Floor, Suite 835
Boston, MA  02114

Phone: 617-726-5532

Email: parkinsons@partners.org

To schedule an appointment:

Appointments can be scheduled by calling: 617-726-5532.

Prior to your first appointment, ask your primary care physician or referring doctor to fax pertinent medical records to the office.

Translation services are available. Please inform us if you need the assistance of a translator.

If you are a new patient to Mass General:

Call to obtain a registration number: 866-211-6588

What to bring to your appointment:

  • Your registration card, insurance card, and co-pay
  • Any medical records and MRI scans that have not been sent to the office
  • List of your current medications

    Parkinson's disease is a neurodegenerative condition, meaning symptoms may gradually change over time. There are several systems for classifying the progression of Parkinson's. Some focus on how they impact daily life, while others look at clinical aspects of the condition.

    What Are the Five Stages of Parkinson's Disease?

    The original system for classifying Parkinson's disease progression into stages is called the "Hoehn and Yahr" scale, named for the two people who developed it. It defines five stages of Parkinson's disease based on the level of clinical disability associated with symptoms.

    The first two stages are considered "early-stage" Parkinson's, while stages 4 and 5 are considered "advanced-stage" Parkinson's disease.

    • Stage 1: In the Hoehn and Yahr scale, the first stage involves symptoms limited to one side that don't cause functional disability, such as a minor tremor in one hand.
    • Stage 2: Stage 2 Parkinson's disease involves symptoms on both sides of the body that don’t cause balance impairments.
    • Stage 3: Stage 3 Parkinson's disease describes someone who is still physically independent but has bilateral (both sides) symptoms with mild to moderate disability.
    • Stage 4: Stage 4 Parkinson's disease indicates a person who has severe disability but can still stand and walk on their own.
    • Stage 5: End-stage Parkinson's disease, on the Hoehn and Yahr scale, describes a person who is confined to a bed or wheelchair by their symptoms.

    Other Scales for Parkinson's Disease Progression

    The Hoehn and Yahr scale is still used occasionally, but since the 1980s, clinicians have developed other scales and systems for classifying the progression of Parkinson's. Part of the reason for this is that the Hoehn and Yahr scale uses very broad categories, making it hard to determine what treatments or interventions will be helpful.

    Current Parkinson's staging and rating systems help doctors identify how Parkinson's disease affects a patient's life and recommend solutions and treatments that can help.

    Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)

    The most common scale to assess Parkinson's symptoms today is the MDS-UPDRS. It contains four sections that evaluate the disease:

    • Non-motor experiences of daily living: The first component of the scale addresses mental and emotional aspects of the disease, such as depression, hallucinations, sleep disturbances, and cognitive impairment.
    • Motor experiences of daily living: The second component addresses the movement symptoms of Parkinson's, such as tremors, the ability to swallow, your balance, and the ability to dress and care for yourself.
    • Motor examination: The third section provides criteria for your doctor to evaluate the movement effects of the disease, such as speed of movement, severity of tremors, etc.
    • Motor complications: The final section helps your doctor evaluate your response to medication and the impact of treatment on your life, including how much of your time is spent with symptoms and the degree to which symptoms determine how you spend your time.

    FAQs about Progression of Parkinson's

    You may have questions about how your Parkinson's will progress and how much time you have. Some of the most common are:

    How fast does Parkinson's disease progress?

    There's no hard and fast timeline for the stages of Parkinson's disease. Every patient is different, and lifestyle factors can have a significant impact on Parkinson's progression. However, most people experience a slow progression that can take place over decades.

    Physicians at the Mass General Parkinson's Disease Center of Excellence are expertly trained in the diagnosis and treatment of Parkinson’s disease. Learn more by requesting an appointment.

    What worsens symptoms of Parkinson's disease?

    Parkinson's symptoms can be aggravated by:

    • Stress
    • Poor diet
    • Lack of exercise
    • Complications from certain medications

    Growing evidence suggests that regular exercise may help slow the progression of Parkinson's disease.

    FAQs about Parkinson's Symptoms by Stage

    The progression of Parkinson's symptoms varies widely from one person to another, but it's natural to wonder what you can expect.

    At what stage of Parkinson's does dementia start?

    It varies. Parkinson's disease dementia—cognitive impairments attributed to PD—is diagnosed when a person with Parkinson's has a significant cognitive decline. However, it often happens after many years of motor symptoms. If cognitive decline is an early symptom of your Parkinsonism, it may be due to a related condition called "dementia with Lewy bodies."

    What stage of Parkinson's is sleeping all the time?

    Fatigue can be a symptom at any stage of Parkinson’s. It can be due to the condition itself but can also be a side effect of medication.

    At what stage of Parkinson's does freezing occur?

    Freezing, a temporary inability to move, is most common in the middle to late stages of Parkinson's. It can affect walking and potentially lead to falls.

    Can Parkinson’s affect swallowing?

    Difficulty swallowing (dysphagia) can occur at any stage of Parkinson's, but typically more at moderate or advanced stages. If your dysphagia worsens, it can lead to increased risk of pneumonia or problems getting adequate nutrition.

    When does falling occur in Parkinson’s?

    Falling becomes more common with the balance problems associated with mid-stage Parkinson's. Early falls can be a sign of other conditions that are related to but different from typical Parkinson’s.

    When does Parkinson’s cause hallucinations?

    Hallucinations can occur at any stage but are most common in the late stages of Parkinson's disease. It is typically associated with changes in thinking and memory, and can be aggravated by Parkinson’s medications.

    Our Parkinson’s Doctors