Rating Scales

Doctors use clinical rating scales to characterize the movement and non-movement symptoms of PD, how severe they are, and their impact on a person’s daily activities. Clinical scales also help doctors track the progression of PD and are used in clinical trials. In addition to the Hoehn and Yahr Scale described above, examples of widely used clinical scales for PD include:

A. Unified Parkinson’s Disease Rating Scale (UPDRS)

A commonly used and validated tool originally developed in the 1980s by a Parkinson’s Foundation researcher. It contains four parts:
1. Mentation, behavior and mood
2. Activities of daily living
3. Motor examination
4. Complications of therapy

B. Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) *gold standard for objective assessment

A revision and expansion of the UPDRS, published in 2008. It is a more comprehensive scale developed to evaluate the various aspects of PD. The four components included in this scale are:
1. Non-movement aspects of experiences of daily living
2. Movement aspects of experiences of daily living
3. Movement examination
4. Movement complications

C. Unified Dyskinesia Rating Scale (UDysRS)

Used to evaluate abnormal involuntary movements (dyskinesia) that occur with advancing PD.

D. Schwab and England Activities of Daily Living Scale

Uses percentages to assess a person’s level of functional independence to complete daily chores.

E. Parkinson’s Disease Questionnaire (PDQ-39) *gold standard for qualitative/subjective assessment

A 39-item self-reported questionnaire assessing PD-specific health related functioning and well-being across eight quality of life dimensions. There is also a short-form version derived from the PDQ-39, the PDQ-8.

F. Non-Motor Symptoms Questionnaire (NMSQ)

A patient-based screening tool designed to draw attention to the presence of non-movement symptoms in people with PD.

G. Non-Motor Symptoms Scale for Parkinson’s Disease (NMSS)

A 30-item rater-based scale to measure the severity and frequency of a wide range of non-movement symptoms across nine dimensions in people with PD.

H. Patient diaries and/or kinematic sensor

They may provide invaluable insights on motor fluctuations in relation to medication intake. Increasingly, clinicians and researchers are exploring new kinematic sensor technologies to help detect and measure motor symptoms and fluctuations.