– Unified Parkinson’s Disease Rating Scale (UPDRS)

DOWNLOAD the Unified Parkinson’s Disease Rating Scale (UPDRS) HERE

The UPDRS is comprised of four parts. Each has multiple points that are individually scored, using zero for normal or no problems, 1 for minimal problems, 2 for mild problems, 3 for moderate problems, and 4 for severe problems. The sum of the scores is used to determine the severity of the disease. 199 points indicates total disability and 0 points indicates no disability.

In 2001, the Movement Disorder Society (MDS) updated the rating scale with involvement from patients and caregivers. The updated scale is referred to as the UPDRS-MDS, and it was published in 2008 and now includes the following sections: (Diagnosis – Rating Scales, 2017)

Part 1: Intellectual function, mood, behavior

  • Forgetfulness, disorientation in time and space
  • Vivid dreaming
  • Hallucinations
  • Delusions and paranoia
  • Depressed mood
  • Anxious mood
  • Apathy
  • Features of dopamine dysregulation syndrome
  • Nighttime sleep problems
  • Daytime sleepiness
  • Pain and other sensations
  • Urinary problems
  • Constipation problems
  • Lightheadedness on standing
  • Fatigue (Diagnosis – Rating Scales, 2017)

Part 2: Activities of daily living

  • Speech: difficulty being understood
  • Salivation and drooling
  • Chewing and swallowing
  • Cutting food
  • Small handwriting
  • Needing help with getting dressed, buttons, arms in sleeves
  • Requires assistance with bathing, brushing teeth
  • Trouble doing hobbies and other activities
  • Difficulties with turning in bed
  • Tremor impact on activities
  • Getting in and out of bed
  • Walking, balance, falling
  • Freezing (Diagnosis – Rating Scales, 2017)

Part 3: Motor examination

  • Speech – volume, diction
  • Reduced facial expressions
  • Rigidity
  • Finger tapping
  • Slowed hand movements
  • Rapid alternating movements of hands (pronation-supination)
  • Toe tapping
  • Leg agility – when tapping heel on the ground, is it slowed, early fatiguing
  • Arising from a chair – degree of difficulty
  • Gait – shuffling, walking with difficulty
  • Freezing of gait
  • Postural stability – difficulty recovering balance
  • Posture – stooped
  • Global spontaneity of movement (body bradykinesia) – slowness of movement, lack of movement
  • Tremor at rest (Diagnosis – Rating Scales, 2017)

Part 4: Motor complications

  • Dyskinesia, including time spent with dyskinesia, functional impact of dyskinesia, and painful off-state dystonia
  • Motor fluctuations, including time spent in the off state, functional impact of fluctuations, and complexity of motor fluctuations (Diagnosis – Rating Scales, 2017)