Parkinson's disease Braak staging

Written by Liu Hong Mei

Neurology

Updated on April 02, 2025

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Parkinson's disease Braak staging is generally divided into five stages:

Stage 1 refers to unilateral symptoms only, such as tremors or stiffness in one hand or one foot, with symptoms confined to one side of the body and not crossing the midline.

Stage 2 refers to mild symptoms on both sides, such as tremors in both hands or throughout the body, but without impairment of balance.

Stage 3 refers to more pronounced bilateral symptoms, such as difficulty lifting legs, taking small shuffling steps, leaning forward, or instability when holding a bowl while eating, but capable of living normally.

Stage 4 refers to the loss of most of the ability for autonomous activity.

Stage 5 refers to a complete loss of the ability to live independently.

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Can Parkinson's patients drink alcohol?

It is recommended that patients with Parkinson's disease avoid drinking alcohol. This is because the condition in Parkinson's patients is caused by the death of certain neurons in the substantia nigra of the midbrain. It is well-known that alcohol has a direct damaging effect on neurons. Therefore, drinking alcohol could potentially worsen the symptoms of Parkinson's disease, and it is advised not to drink alcohol. Additionally, patients with Parkinson's disease are prone to panic and unstable gait. If alcohol consumption affects the function of the cerebellum, it will exacerbate the patient's instability in walking, making them very prone to falls and potentially causing complications such as fractures. Furthermore, drinking alcohol can lead to orthostatic hypotension, which is a lower blood pressure when standing up. Parkinson's disease itself can also cause this type of orthostatic hypotension, and the combination of the two can cause a significant drop in blood pressure in patients, posing a risk when standing.

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Neurology

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Late-stage symptoms of Parkinson's disease

Parkinson's disease is a progressively worsening neurodegenerative disorder of the nervous system, initially manifesting as bradykinesia, resting tremor, and other symptoms. As the disease progresses, the symptoms become increasingly severe. In the later stages, symptoms may include significant postural and gait abnormalities, such as obvious stooping and difficulty starting to walk, a phenomenon known as freezing, and turning around can also be difficult. Additionally, in the late stages, swallowing dysfunction may occur, leading to clinical signs such as coughing while drinking water and articulation disorders. Furthermore, individuals with Parkinson's disease are particularly prone to falling in the later stages due to impaired balance functions.

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Causes of Parkinson's Disease

The cause of Parkinson's disease is mainly due to a part of the brain called the brainstem, which has some black moles and clusters containing a large number of neurons that can produce dopamine. The death of these neurons in the substantia nigra of the midbrain, caused by various factors, leads to Parkinson's disease. This results in noticeable slowness of movement in the limbs, muscle rigidity, as well as tremors, and unstable walking and other clinical manifestations. The causes of the death of dopaminergic neurons in the substantia nigra include genetic factors. Additionally, age is the biggest cause of the disease. Furthermore, dysfunctions in mitochondrial function, ischemia and hypoxia in the midbrain, certain traumas, and the use of drugs that deplete dopamine can all potentially cause Parkinson's disease.

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Geriatrics

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What are the symptoms of Parkinson's disease?

The main symptoms of Parkinson's disease are divided into two major categories: motor symptoms and non-motor symptoms. The motor symptoms include bradykinesia and hypokinesia, specifically characterized by slow movement speed and reduced amplitude. In daily life, this results in clumsiness with actions such as difficulty standing up, small arm swings while walking, or even no swinging at all, a lack of facial expressions, and progressively smaller handwriting. The second type is resting tremor, which includes pill-rolling movements along with muscle rigidity and postural and gait imbalances, such as a panicked gait or taking very small steps that accelerate and become faster without the ability to stop or turn promptly. Non-motor symptoms include issues such as olfactory dysfunction, sleep disturbances, constipation, and depression.

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Can Parkinson's disease be cured?

Parkinson's disease is a degenerative disease of the nervous system that currently cannot be cured in medicine. It is important to choose the right treatment plan to avoid being deceived. Parkinson's disease is mainly caused by the irreversible death of dopaminergic neurons in the substantia nigra, resulting in clinical manifestations such as bradykinesia, muscular rigidity, and tremors in limbs. Other non-motor symptoms include reduced sense of smell, constipation, anxiety, depression, and orthostatic hypotension. Treatment primarily focuses on symptomatic relief, and it is not expected to achieve complete remission. Commonly used medications include levodopa, anticholinergics, and activators of levodopa and dopamine receptors. Symptoms in patients usually progressively worsen, and curing the disease is very difficult.