Unified Parkinson's disease rating scale

Last updated
Unified Parkinson's disease rating scale
Purposeused to follow the longitudinal course of Parkinson's disease

The unified Parkinson's disease rating scale (UPDRS) is used to follow the longitudinal course of Parkinson's disease. The UPD rating scale is the most commonly used scale in the clinical study of Parkinson's disease. [1]


The UPDRS is made up of these sections: [2]

These are evaluated by interview and clinical observation. Some sections require multiple grades assigned to each extremity.

Clinicians and researchers alike use the UPDRS and the motor section in particular to follow the progression of a person's Parkinson's disease. Scientific researchers use it to measure benefits from a given therapy in a more unified and accepted rating system. Neurologists also use it in clinical practice to follow the progression of their patients' symptoms in a more objective manner. [3]

Following the UPDRS scores over time provides insight into the patient's disease progression. For instance Michael J. Fox's symptoms started with a slight tremor, so his motor score would have been less than 10. For most patients, the "mentation, behavior and mood" scores increase later in the disease, but a subset exists for whom those symptoms develop early on. [4]

Similar rating scales

Other rating scales for Parkinson's disease are the Hoehn and Yahr scale and Schwab and England activities of daily living scale, although both of these measures are currently included within the UPDRS in modified format.


In 2007, the Movement Disorder Society (MDS) published a revision of the UPDRS, known as the MDS-UPDRS. [5] The revision became desirable after an MDS-sponsored Task Force on Rating Scales for Parkinson's Disease highlighted the limitations of the original UPDRS. [6] Two major limitations include the lack of consistent anchor among subscales and the low emphasis on the nonmotor features of PD. [5] The modified UPDRS retains the four-scale structure with a reorganization of the various subscales. The scales are now titled; (1) nonmotor experiences of daily living (13 items), (2) motor experiences of daily living (13 items), (3) motor examination (18 items), and (4) motor complications (six items). Each subscale now has 0-4 ratings, where 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe. [7]

Related Research Articles

Chorea acanthocytosis Rare autosomal recessive genetic condition

Chorea-acanthocytosis, is a rare hereditary disease caused by a mutation in a gene that directs structural proteins in red blood cells. It belongs to a group of four diseases characterized under the name neuroacanthocytosis. When a patient's blood is viewed under a microscope, some of the red blood cells appear thorny. These thorny cells are called acanthocytes.

Corticobasal degeneration (CBD) is a rare neurodegenerative disease involving the cerebral cortex and the basal ganglia. CBD symptoms typically begin in people from 50 to 70 years of age, and the average disease duration is six years. It is characterized by marked disorders in movement and cognition, and is classified as one of the Parkinson plus syndromes. Diagnosis is difficult, as symptoms are often similar to those of other disorders, such as Parkinson's disease, progressive supranuclear palsy, and dementia with Lewy bodies, and a definitive diagnosis of CBD can only be made upon neuropathologic examination.

Cognitive pretesting, or cognitive interviewing, is a field research method where data is collected on how the subject answers interview questions. It is the evaluation of a test or questionnaire before it's administered. It allows survey researchers to collect feedback regarding survey responses and is used in evaluating whether the question is measuring the construct the researcher intends. The data collected is then used to adjust problematic questions in the questionnaire before fielding the survey to the full sample of people.

The Hoehn and Yahr scale is a commonly used system for describing how the symptoms of Parkinson's disease progress. It was originally published in 1967 in the journal Neurology by Margaret Hoehn and Melvin Yahr and included stages 1 through 5. Since then, a modified Hoehn and Yahr scale was proposed with the addition of stages 1.5 and 2.5 to help describe the intermediate course of the disease.

Management of Parkinson's disease due to the chronic nature of Parkinson's disease (PD), a broad-based program is needed that includes patient and family education, support-group services, general wellness maintenance, exercise, and nutrition. At present, no cure for the disease is known, but medications or surgery can provide relief from the symptoms.


Dihydroergocryptine is a dopamine agonist of the ergoline chemical class that is used as an antiparkinson agent. Dihydroergocryptine has been shown to be particularly effective as monotherapy in the early stages of Parkinson's disease. Initial monotherapy with a dopamine agonist is associated with reduced risk for motor complications in Parkinson patients relative to levodopa. DHEC, like other dopamine agonists, aims to mimic the endogenous neurotransmitter and exert an antiparkinsonian effect. Recent evidence also supports that dopamine receptor agonists, instead of L-DOPA may slow or prevent the progression of Parkinson's disease.

Dopamine dysregulation syndrome

Dopamine dysregulation syndrome (DDS) is a dysfunction of the reward system observed in some individuals taking dopaminergic medications for an extended length of time. It typically occurs in people with Parkinson's disease (PD) who have taken dopamine agonist medications for an extended period of time. It is characterized by self-control problems such as addiction to medication, gambling, or sexual behavior.

Parkinsons disease Long-term degenerative neurological disorder

Parkinson's disease (PD), or simply Parkinson's is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly and, as the disease worsens, non-motor symptoms become more common. The most obvious early symptoms are tremor, rigidity, slowness of movement, and difficulty with walking. Cognitive and behavioral problems may also occur with depression, anxiety, and apathy occurring in many people with PD. Parkinson's disease dementia becomes common in the advanced stages of the disease. Those with Parkinson's can also have problems with their sleep and sensory systems. The motor symptoms of the disease result from the death of cells in the substantia nigra, a region of the midbrain, leading to a dopamine deficit. The cause of this cell death is poorly understood, but involves the build-up of misfolded proteins into Lewy bodies in the neurons. Collectively, the main motor symptoms are also known as "parkinsonism" or a "parkinsonian syndrome".

The Eating Disorder Inventory (EDI) is a self-report questionnaire used to assess the presence of eating disorders, (a) anorexia nervosa both restricting and binge-eating/purging type; (b) bulimia nervosa; and (c) eating disorder not otherwise specified including binge eating disorder. The original questionnaire consisted of 64 questions, divided into eight subscales. It was created in 1984 by David M. Garner and others. There have been two subsequent revisions by Garner: the Eating Disorder Inventory-2 (EDI-2) and the Eating Disorder Inventory-3 (EDI-3).

The Movement Disorder Society

The International Parkinson and Movement Disorder Society (MDS) is a professional society of clinicians, scientists, and other healthcare professionals who are interested in movement disorders. The field of Movement Disorders includes the following areas: Parkinson's disease and parkinsonism, ataxia, dystonia, chorea and Huntington's disease, tics and Tourette syndrome, myoclonus and startle, restless leg syndrome, stiff person syndrome, tremor and essential tremor, spasticity, and gait disorders.

Parkinsonian gait

Parkinsonian gait is the type of gait exhibited by patients suffering from Parkinson's disease (PD). It is often described by people with Parkinson's as feeling like being stuck in place, when initiating a step or turning, and can increase the risk of falling. This disorder is caused by a deficiency of dopamine in the basal ganglia circuit leading to motor deficits. Gait is one of the most affected motor characteristics of this disorder although symptoms of Parkinson's disease are varied.

The Health Dynamics Inventory (HDI) is a 50 item self-report questionnaire developed to evaluate mental health functioning and change over time and treatment. The HDI was written to evaluate the three aspects of mental disorders as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM): "clinically significant behavioral or psychological syndrome or pattern...associated with present distress...or disability". This also corresponds to the phase model described by Howard and colleagues Accordingly, the HDI assesses (1) the experience of emotional or behavioral symptoms that define mental illness, such as dysphoria, worry, angry outbursts, low self-esteem, or excessive drinking, (2) the level of emotional distress related to these symptoms, and (3) the impairment or problems fulfilling the major roles of one's life.

Lee Silverman voice treatment

The Lee Silverman Voice Treatment – LOUD is a treatment for speech disorders associated with Parkinson's disease (PD). It focuses on increasing vocal loudness and is delivered by a speech therapist in sixteen one-hour sessions spread over four weeks. A derivative of this treatment, known as LSVT BIG, is used in treating movement aspects of Parkinson's disease.

The European Huntington's Disease Network is a Europe-wide network of professionals and people affected by Huntington's disease, who collaborate to organise and perform research into the condition, and improve the care of HD-affected individuals.

The International Cooperative Ataxia Rating Scale (ICARS) is an outcome measure that was created in 1997 by the Committee of the World Federation of Neurology with the goal of standardizing the quantification of impairment due to cerebellar ataxia. The scale is scored out of 100 with 19 items and 4 subscales of postural and gait disturbances, limb ataxia, dysarthria, and oculomotor disorders. Higher scores indicate higher levels of impairment.

The REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) is a specific questionnaire for rapid eye movement behavior disorder (RBD) developed by Stiasny-Kolster and team, to assess the most prominent clinical features of RBD. It is a 10-item, patient self-rating instrument with short questions to be answered by either 'yes' or 'no'. The validity of the questionnaire was studied by researchers and they have observed it to perform with high sensitivity and reasonable specificity in the diagnosis of RBD.

Gait variability seen in Parkinson's Disorders arise due to cortical changes induced by pathophysiology of the disease process. Gait rehabilitation is focused to harness the adapted connections involved actively to control these variations during the disease progression. Gait variabilities seen are attributed to the defective inputs from the Basal Ganglia. However, there is altered activation of other cortical areas that support the deficient control to bring about a movement and maintain some functional mobility.

Parkinson's disease dementia (PDD) is dementia that is associated with Parkinson's disease (PD). Together with dementia with Lewy bodies (DLB), it is one of the Lewy body dementias characterized by abnormal deposits of Lewy bodies in the brain.

Sue Ellen Leurgans is a biostatistician known for her work on disorders of human movement, including those caused by occupational injury and Parkinson's disease. She is a professor of neurological sciences at the Rush University Medical Center in Chicago.

The Schwab and England ADL scale is a method of assessing the capabilities of people suffering from impaired mobility. Originally presented at a Parkinson's disease conference, the scale assesses the difficulties patients have completing daily activities or chores. The scale uses percentages to represent how much effort and dependence on others patients need complete daily chores. The rating may be given by a professional or by the person being tested.


  1. Ramaker, Claudia; Marinus, Johan; Stiggelbout, Anne Margarethe; van Hilten, Bob Johannes (1 September 2002). "Systematic evaluation of rating scales for impairment and disability in Parkinson's disease". Movement Disorders. 17 (5): 867–876. doi:10.1002/mds.10248. PMID   12360535.
  2. Comprehensive pharmacy review, Leon Shargel, 6th edition, p. 998.
  3. "Frequently Asked Questions". Parkinson's Disease Foundation. 23 March 2009. Archived from the original on 19 July 2011. Retrieved 31 January 2011.
  4. Rosenbaum, Richard B. (2006). Understanding Parkinson's Disease: A Personal and Professional View. Greenwood Publishing Group. ISBN   978-0-275-99166-1.
  5. 1 2 Goetz, Christopher G.; Fahn, Stanley; Martinez-Martin, Pablo; Poewe, Werner; Sampaio, Cristina; Stebbins, Glenn T.; Stern, Matthew B.; Tilley, Barbara C.; Dodel, Richard; Dubois, Bruno; Holloway, Robert; Jankovic, Joseph; Kulisevsky, Jaime; Lang, Anthony E.; Lees, Andrew; Leurgans, Sue; LeWitt, Peter A.; Nyenhuis, David; Olanow, C. Warren; Rascol, Olivier; Schrag, Anette; Teresi, Jeanne A.; Van Hilten, Jacobus J.; LaPelle, Nancy (1 January 2007). "Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Process, format, and clinimetric testing plan". Movement Disorders. 22 (1): 41–47. doi: 10.1002/mds.21198 . PMID   17115387.
  6. Movement Disorder Society Task Force on Rating Scales for Parkinson's Disease (July 2003). "The Unified Parkinson's Disease Rating Scale (UPDRS): status and recommendations". Movement Disorders. 18 (7): 738–50. doi:10.1002/mds.10473. PMID   12815652.
  7. "Parkinson's Disease Diagnostic Criteria". BMJ. Retrieved 8 May 2012.