Unified Parkinson's Disease Rating Scale
The Unified Parkinson's Disease Rating Scale (UPDRS) is a rating scale used to follow the longitudinal course of Parkinson's disease. The UPDRS is the most commonly used scale in the clinical study of Parkinson's Disease.
The UPDRS is made up of the following sections:
- Part I: evaluation of Mentation, behavior, and mood;
- Part II: self-evaluation of the activities of daily life (ADLs) including speech, swallowing, handwriting, dressing, hygiene, falling, salivating, turning in bed, walking, cutting food;
- Part III: clinician-scored motor evaluation;
- Part IV: Hoehn and Yahr staging of severity of Parkinson disease.
- Part V: Schwab and England ADL scale.
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.
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 there is a subset for whom those symptoms develop early on.
Similar rating scales
Other rating scales for Parkinson's disease are 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. The revision became desirable after an MDS-sponsored Task Force on Rating Scales for Parkinson’s Disease highlighted the limitations of the original UPDRS. Two major limitations include the lack of consistent anchor among subscales as well as the low emphasis on the nonmotor features of PD. The modified UPDRS retains the four-scale structure with a re-organization of the various subscales. The scales are now titled; (1) non-motor experiences of daily living (13 items), (2) motor experiences of daily living (13 items), (3) motor examination (18 items) and (4) motor complications (6 items). Each subscale now has 0-4 ratings, where 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe.
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