Unified Parkinson's Disease Rating Scale

Unified Parkinson's Disease Rating Scale (UPDRS) is a rating tool used to gauge the the severity and progression of Parkinson’s disease in patients. The UPDRS scale consists of the following six segments: 1) Mentation, Behavior, and Mood, 2) ADL, 3) Motor sections, 4) Complications of Therapy (in the past week) 5) Modified Hoehn and Yahr Scale, and 6) Schwab and England ADL scale. The first four segments are made up of 42 items grouped into four subscales. The UPDRS was developed in 1987 as a gold standard by neurologists for monitoring the response to medications used to decrease the signs and symptoms of Parkinson's.

Unified Parkinson's Disease Rating Scale

Intended Population

People with Parkinson disease.

Method of Use

Equipment Required:

Pen and Paper

Duration:

20 mins

Scoring:

Parts 1 to 3 are scored on a 0-4 rating scale. Part 4 is scored with yes and no ratings. Higher scores show increased severity. Then the administrator rates the patient on the H and Y Scale and the Schwab and England Activities of Daily Living Scale.

Permission of the International Parkinson and Movement Disorder Society is required before using the scale.

Evidence

Reliability

The UPDRS has shown excellent internal consistency across multiple studies and across stages of disease severity as measured by the Hoehn and Yahr staging system.
Inter-rater reliability was found to be adequate for the total UPDRS as well as the Activities of Daily Living and the Motor Examination sections.

The Intra-class correlation coefficients were very high: total score: 0.92; Mentation: 0.74; Activities of Daily Living: 0.85; Motor: 0.90.

Validity

Adequate Face Validity

Studies have demonstrated that the UPDRS is sensitive to change in clinical status.

Miscellaneous

The UPDRS has been modified since its conception into:

Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS): The revision was made after an MDS-sponsored Task Force on Rating Scales for Parkinson's Disease highlighted the limitations of the original UPDRS. The scale was modifies into 4 parts: Part I, Nonmotor aspects of experiences of daily living (6 items assessed by interview and 7 items by self-assessment); Part II, Motor aspects of experiences of daily living (13 self-assessed items); Part III, Motor examination (18 items resulting in 33 scores by location and lateralization); and part IV, Motor complications (3 items for dyskinesia and 3 for fluctuation).
UPDRS-8: 8 items from the original UPDRS comprise the UPDRS-8. All are rated on a 5-point (0–4) scale. The items selected are:

Nonmotor: Cognition (UPDRS item 1), Mood (UPDRS item 3)
Motor: Rest tremor upper extremity—right, left (UPDRS item 20), Finger taps—right, left (UPDRS item 23), Gait (UPDRS item 29)
Motor complications: Off time (UPDRS item 39), Dyskinesia duration (UPDRS item 32), Dyskinesia disability (UPDRS item 33)