– The Hoehn and Yahr Scale

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The Hoehn and Yahr Scale

This test is named for its authors. It was published in 1967 and was the first rating scale to describe the progression of PD. The Hoehn and Yahr scale describe the five stages of PD progression: (Diagnosis – Rating Scales, 2017)

Stage One:

In stage one, the earliest stage, the symptoms of PD are mild and only seen on one side of the body (unilateral involvement), and there is usually minimal or no functional impairment. The symptoms of PD at stage one may be so mild that the person doesn’t seek medical attention or the physician is unable to make a diagnosis. Symptoms at stage one may include tremor, rigidity, or slowness of movement in the arm or leg on one side of the body, or one side of the face may be affected, impacting the expression. (Diagnosis – Rating Scales, 2017)

Stage Two

Stage Two of Parkinson’s Disease – Stage two is still considered early disease in PD, and it is characterized by symptoms on both sides of the body (bilateral involvement) or at the midline without impairment to balance. Stage two may develop months or years after stage one. Symptoms of PD in stage two may include the loss of facial expression on both sides of the face and decreased blinking. Speech abnormalities may be present, such as soft voice, monotone voice, fading volume after starting to speak loudly, or slurring speech. There also may be stiffness or rigidity of the muscles in the trunk that may result in neck or back pain, stooped posture, and general slowness in all activities of daily living. Diagnosis may be easy at this stage if the patient has a tremor, however, if stage one was missed and the only symptoms of stage two are slowness or lack of spontaneous movement, PD could be misinterpreted as only advancing age. (Diagnosis – Rating Scales, 2017)

Stage Three

Stage Three of Parkinson’s Disease – Stage three is considered mid-stage and is characterized by loss of balance and slowness of movement. Balance is compromised by the inability to make the rapid, automatic, and involuntary adjustments necessary to prevent falling, and falls are common at this stage. All other symptoms of PD are also present at this stage, and generally diagnosis is not in doubt at stage three. An important clarifying factor of stage three is that the patient is still fully independent in their daily living activities, such as dressing, hygiene, and eating. (Diagnosis – Rating Scales, 2017)

Stage Four

Stage Four of Parkinson’s Disease – In stage four, PD has progressed to a severely disabling disease. Patients with stage four PD may be able to walk and stand unassisted, but they are noticeably incapacitated. Many use a walker to help them. At this stage, the patient is unable to live an independent life and needs assistance with some activities of daily living. (Diagnosis – Rating Scales, 2017) 5. Stage Five of Parkinson’s Disease –

Stage Five

Stage five is the most advanced and is characterized by confinement to a bed or wheelchair. People with stage five PD may be unable to rise from a chair or get out of bed without help, they may have a tendency to fall when standing or turning, and they may freeze or stumble when walking. Around-the-clock assistance is required at this stage to reduce the risk of falling and help the patient with all daily activities. At stage five, the patient may also experience hallucinations or delusions. (Diagnosis – Rating Scales, 2017)
While the symptoms worsen over time, it is worth noting that some patients with PD never reach stage five. People with PD may also never experience some of the above symptoms. In addition, there are treatments available that can help at every stage of the disease. (Diagnosis – Rating Scales, 2017)