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Unified Parkinson's disease rating scale

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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]

  • 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, and cutting food
  • Part III: clinician-scored monitored motor evaluation
  • Part IV: complications of therapy
  • Part V: Hoehn and Yahr staging of severity of Parkinson's disease
  • Part VI: 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.[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. Score ranges from 0 to 260,[7][8] with 0 indicating no disability and 260 indicating total disability. The scales are:

  • Part I: Nonmotor experiences of daily living: 13 items. Score range: 0–52,[8] 10 and below is mild, 22 and above is severe.[9]
  • Part II: Motor experiences of daily living: 13 items. Score range: 0–52,[8] 12 and below is mild, 30 and above is severe.[9]
  • Part III: Motor examination: 18 items. Score range: 0–132,[8] 32 and below is mild, 59 and above is severe.[9]
  • Part IV: Motor complications: 6 items. Score range: 0–24,[8] 4 and below is mild, 13 and above is severe.[9]

Each item has 0–4 ratings: 0 (normal), 1 (slight), 2 (mild), 3 (moderate), and 4 (severe).[10]


  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. S2CID 2562332.
  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. ^ a b 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. S2CID 1759369.
  7. ^ Sheshadri, Veena; Rowland, Nathan C.; Mehta, Jigesh; Englesakis, Marina; Manninen, Pirjo; Venkatraghavan, Lashmi (2017). "Comparison of General and Local Anesthesia for Deep Brain Stimulator Insertion: A Systematic Review". Canadian Journal of Neurological Sciences. 44 (6): 697–704. doi:10.1017/cjn.2017.224. ISSN 0317-1671. PMID 28920562.
  8. ^ a b c d e Balestrino, Roberta; Hurtado-Gonzalez, Carlos Alberto; Stocchi, Fabrizio; Radicati, Fabiana Giada; Chaudhuri, K. Ray; Rodriguez-Blazquez, Carmen; Martinez-Martin, Pablo (2019-11-27). "Applications of the European Parkinson's Disease Association sponsored Parkinson's Disease Composite Scale (PDCS)". npj Parkinson's Disease. 5 (1): 26. doi:10.1038/s41531-019-0097-1. ISSN 2373-8057. PMC 6881347. PMID 31798050.
  9. ^ a b c d Skorvanek, Matej; Martinez-Martin, Pablo; Kovacs, Norbert; Rodriguez-Violante, Mayela; Corvol, Jean-Christophe; Taba, Pille; Seppi, Klaus; Levin, Oleg; Schrag, Anette; Foltynie, Thomas; Alvarez-Sanchez, Mario; Arakaki, Tomoko; Aschermann, Zsuzsanna; Aviles-Olmos, Iciar; Benchetrit, Eve (2017). "Differences in MDS-UPDRS Scores Based on Hoehn and Yahr Stage and Disease Duration". Movement Disorders Clinical Practice. 4 (4): 536–544. doi:10.1002/mdc3.12476. PMC 6174385. PMID 30363418.
  10. ^ "Parkinson's Disease Diagnostic Criteria". BMJ. Archived from the original on 28 August 2021. Retrieved 8 May 2012.