What are the different forms and stages of Parkinson's disease?



we know that Parkinson disease is not just a single entity there are many different subtypes of Parkinson disease at least 30 years ago we described two major subtypes of Parkinson disease one is referred to as the tremor dominant form of Parkinson disease which represents about 75% of all patients with Parkinson disease and the second subtype is what we referred to us P I GD partial instability gait difficulty form of Parkinson the first subtype the tremor dominant form of Parkinson disease often starts at a relatively younger age somewhere between the ages of 45 and 55 the onset usually is tremor sort of a rest tremor and usually in the hand and then it spreads to the opposite side and it may involve other parts of their bodies such as the lips chin jaw legs but it never involves the head so if one sees a an individual with oscillation of your head like no no no yes yes yes that individual almost certainly does not have Parkinson disease but has another condition namely essential tremor which is frequently confused with Parkinson disease now for long term it has to be it was thought that essential tremor and Parkinson disease are totally distinct disorders and this is probably true still for majority of patients with Parkinson disease an essential tremor but we have accumulated some evidence of which over the last two or three decades to indicate that there is a subtype of patients with essential tremor that may evolve into this tremor dominant form of Parkinson disease and that some patients with essential tremor are at an increased risk for developing Parkinson disease so this is the tremor dominant form of Parkinson disease the most common form of Parkinson disease usually has a much more favorable prognosis than the second subtype of Parkinson disease the P IgD full of Parkinson disease in the in this form of Parkinson disease the P IgD of postural instability gait difficulty form Parkinson patients often start with a shuffling gait with some difficulty with their balance with tendency to fall your forward or backwards they develop Falls early in the course of the disease the natural course of progression in the P IgD form of Parkinson disease is much more rapid than in the tremor dominant so the prognosis is less favorable and they do not respond as well to n type Parkinson medications such as levodopa so when I see patients at Parkinson disease if they have the tremor dominant form Parkinson disease I may tell them well the bad news is that you have Parkinson disease but the good news is that you have the best kind of Parkinson disease the kind of Parkinson that generally has a good prognosis now in addition to the tremor form Parkinson disease and the P IgD form of Parkinson disease we often subdivide Parkinson disease according to the age of onset so there could be juvenile form of Parkinson disease starting in childhood it's extremely rare but it does it does occur and then there's a young answer'd form of Parkinson disease that may start in the 20s or 30s these patients often respond very well to levodopa but are much more vulnerable to the side effects of the Vltava such as dyskinesias that twisted jerking type involuntary movements and that is a characteristic feature of the young concert Parkinson disease and then there is a late onset Parkinson disease which tends to be more of the PID d4 Parkinson these patients tend to develop the gait difficulty balance problem early on and they may often develop cognitive decline early on and dementia becomes the dominant feature in the more advanced stages of the disease speaking of stages of the disease we divide the natural course of progression Parkinson disease into the five stages the so called hone in yar stages where stage one represents chiefly unilateral one-sided symptoms such as tremor stage two means that the symptoms occur bilaterally on both sides stage three means that the patient is begin to develop some difficulties with their balance but still are able to ambulate without assistance Stage four means they require assistance with ambulation and Stage five usually means that the patients are wheelchair-bound or bedridden so these are the five stages of Parkinson disease and our goal of course is to maintain the patient in the earliest stages of the disease as possible with appropriate treatment you

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