Stages of MND

June 21, 2024 Neurological Care, Private Nursing

Stages of MND

How MND progresses

Motor neurone disease gets gradually worse over time. Swallowing, breathing and moving around become increasingly difficult. These worsening symptoms result in the need of treatments such as feeding tube or breathing air through a face mask. Eventually, the condition is fatal, however, there are various factors affecting how long it takes to reach this stage.

The definition of the stages of motor neurone disease (MND) is set out by the progression of its symptoms.

Early Stages

Stage One

In the initial phase, symptoms usually start on one side of the body before spreading. The first noticeable signs often are weakness in hands and grip, slurred speech, weakness in legs, cramps and muscle twitching. These may initially be mild and intermittent, often mistaken for normal aging and fatigue. Early interventions during early stage of MND are critical to maximize the effectiveness of treatment and slowing disease progression.

Stage Two

This stage exhibits a progression of symptoms from the subtle changes observed in the previous stage. Muscle weakness becomes more noticeable and widespread, affecting multiple limbs and muscle groups. Activities of daily living, such as buttoning a shirt or holding utensils, may become difficult. Moreover, as a result of affected walking and balance, individuals may develop an increased dependence on walking aids, such as canes and walkers. Cognitive functions typically remain unimpaired, which allows for active engagement in decision-making and maintaining social relations.

Middle Stage

Stage Three

A significant progression of symptoms and decline of functionality becomes more severe compared to previous stages. Muscle weakness is severe, more prevalent and affects most muscle groups throughout the body. Individuals may experience significant difficulty with mobility, largely depending upon assistance with walking or transferring between positions. Fine motor skills are profoundly impaired, tasks such as dressing, eating and grooming are progressively more challenging. Individuals may be experiencing slurred speech patterns, swallowing difficulties and increased risk of choking. Cognitive functions commonly remain unscathed, allowing individuals awareness and participation in decision-making.

Advanced Stages

Stage Four

This stage brings significant limitations in mobility and wheelchair assistance may be necessary. Swallowing and speech difficulties increase, which results in required assistance of communication aids and altered diets to prevent aspiration.

Stage Five

The most advance stage of MND. Individuals in this stage are typically predominantly or completely immobile, with paralysis affecting most muscles of their body. Full assistance with activities of daily living is needed, notwithstanding personal care, grooming and feeding. Speech may be lost or severely impaired and alternative communication methods, such as eye gaze devices or communication boards in place. Dehydration, malnutrition and aspiration pneumonia are a point of concern at this point due to swallowing difficulties.

Last Stages

Individuals remain alert mentally and cognitively throughout regardless of extensive physical limitations. Palliative care at this stage is vital to manage symptoms and provide comfort together with support for the individual and their loved ones during the end-of-life process. The span of the last stage of motor neurone disease varies, ranging from several months to several years and is unpredictable. Discussions about end-of-life wishes of individuals are imperative to ensure that the support they receive aligns with their preferences and desires.

How can Cavendish Homecare help?

At Cavendish Homecare, we deliver exceptional care in the familiar surroundings of your own home. We provide personalised private motor neurone disease home care tailored to individual needs in London and the Home Counties. To learn more about our care services and how we can assist with your needs, please reach out to our team at 020 3008 5210 or email us We are here to discuss further and address any questions or concerns you may have.

About the Author…

Misha Zemkova

Operations Assistant

Starting her career in Health and Social Care with a Certificate of Higher Education from the Open University, Misha Zemkova is committed to making a positive impact.

As a former volunteer at North London Action for the Homeless, Misha stands out for her exceptional ability to connect with people through active listening. With seven years of invaluable experience as a Key Worker for adults with diverse learning disabilities, Misha brings extensive experience and a deep understanding of caring for individuals with unique needs.

Now a pivotal member of the operations team at Cavendish Homecare, Misha actively supports Nurse Managers and the Bookings team in delivering high-quality care. She has demonstrated outstanding commitment to supporting charity partner Cruse Bereavement through events such as the Virtual TCS London Marathon and Light up the Night.

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