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Unified Parkinson’s Disease Rating Scale (UPDRS)

The UPDRS was developed in an attempt to combine elements of a number of scales and produce a comprehensive, efficient and flexible tool to monitor the impact of Parkinson’s Disease and the degree of disability caused.  Following several trial versions, the scale was officially introduced in 1987 and has since been updated by specialists from the Movement Disorder Society to include new assessments of Non-motor symptoms.

The scale has three sections which evaluate the key areas of disability, together with a fourth section that evaluates any complications of treatment.  In addition, this is frequently accompanied by two further scales used to report on Parkinson’s – the Hoehn and Yahr, and the Schwab and EnglandActivities of Daily Living (ADL) scale.  Although frequently used in combination with the UPDRS, these scales are not part of the UPDRS itself.

Part I  - evaluation of mentation (mental activity or state of mind) or cognition (ability to acquire knowledge), behaviour and mood:

  • intellectual impairment
  • thought disorder
  • motivation/initiative
  • depression

Part II - self evaluation of the activities of daily life:

  • speech
  • salivation
  • swallowing
  • handwriting
  • cutting food
  • dressing
  • hygiene
  • turning in bed
  • falling
  • Freezing
  • walking
  • Tremor
  • sensory difficulties

Part III - evaluation of motor function:

  • speech
  • facial expression
  • tremor at rest
  • action tremor
  • Rigidity
  • finger taps
  • hand movements
  • rotation of the hands and forearms so that the palms face downward
  • rotation of the hands and forearms so that the palms face upward
  • leg agility
  • rising from chair
  • Posture
  • Gait
  • postural stability
  • bradykinesia

Part IV – evaluation of complications of therapy

  • Dyskinesia
  • early morning Dystonia
  • "off-period" deterioration, including the duration of  "off" periods, predictability based on dosage, and whether onset is sudden or gradual
  • anorexia (including nausea and/or vomiting)
  • sleep disturbance
  • Symptomatic orthostasis

Part V  - Hoehn and Yahr scale staging of the severity of Parkinson’s Disease         

Part VI - Schwab and England Activities of Daily Living scale

The UPDRS is applied by a healthcare professional and points are assigned to every item based upon the individual’s response, as well as observation and physical examination. Parts I, II, and III contain 44 questions, and each item is measured on a five-point scale, while part IV contains 11 questions with the scale ranging from 0 to 23. The final cumulative score will range from 0 (no disability) to 199 (total disability).

For further details on use of the the UPDRS see www.movementdisorders.org/MDS-Files1/PDFs/MDS-UPDRS-Rating-Scales/NewUPDRS7308final.pdf