Unified Parkinson's Disease Rating Scale (UPDRS)

Original Editor - Rucha Gadgil

Top Contributors -  


Objective [edit | edit source]

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[1].  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.

Intended Population [edit | edit source]

People with Parkinson disease.

Method of Use [edit | edit source]

Equipment Required:[edit | edit source]

Pen and Paper

Duration:[edit | edit source]

20 mins[2]

Scoring:[edit | edit source]

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[edit | edit source]

Reliability   [edit | edit source]
  • 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[2][3].
  • 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[4][5].
  • The Intra-class correlation coefficients were very high: total score:  0.92; Mentation: 0.74; Activities of Daily Living: 0.85; Motor: 0.90[6][7].
Validity [edit | edit source]
  • Adequate Face Validity[8]
  • Studies have demonstrated that the UPDRS is sensitive to change in clinical status[9].

Miscellaneous [edit | edit source]

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)[9]
  • UPDRS-8[10]: 8 items from the original UPDRS comprise the UPDRS-8. All are rated on a 5-point (0–4) scale. The items selected are:
  1. Nonmotor: Cognition (UPDRS item 1), Mood (UPDRS item 3)
  2. Motor: Rest tremor upper extremity—right, left (UPDRS item 20), Finger taps—right, left (UPDRS item 23), Gait (UPDRS item 29)
  3. Motor complications: Off time (UPDRS item 39), Dyskinesia duration (UPDRS item 32),  Dyskinesia disability (UPDRS item 33)

Links [edit | edit source]

Find the UPDRS scale here.

Find the MDS-UPDRS scale here. For additional information, here.

References[edit | edit source]

  1. Fahn S, Marsden CD, Calne DB, Goldstein M. Recent Developments in Parkinson's Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, pp 15 3-163, 293-304
  2. 2.0 2.1 Martinez-Martin P, Gil-Nagel A, Gracia LM, et al. Unified Parkinson’s disease Rating Scale characteristics and structure. The Cooperative Multicentric Group. Mov Disord 1994;9:76 – 83
  3. Louis ED, Lynch T, Marder K, et al. Reliability of patient completion of the historical section of the Unified Parkinson’s disease Rating Scale. Mov Disord 1996;11:185–192
  4. Rabey JM, Bass H, Bonuccelli U, Brooks D, et al. Evaluation of the short Parkinson’s evaluation scale: a new friendly scale for the evaluation of Parkinson’s disease in clinical drug trials. Clin Neuropharm 1997;20:322–337
  5. Siderowf A, McDermott M, Kieburtz K, et al. Test-retest reliability of the UPDRS in patients with early Parkinson’s disease: results of a multicenter clinical trial. Mov Disord 2002;17:758 –763
  6. Stebbins GT, Goetz CG. Factor structure of the Unified Parkinson’s disease Rating Scale: Motor Examination section. Mov Disord 1998;13:633– 636
  7. Stebbins GT, Goetz CG, Lang AE, et al. Factor analysis of the motor section of the Unified Parkinson’s disease Rating Scale during the off-state. Mov Disord 1999;14:585589
  8. Camicioli R, Grossmann SJ, Spencer PS, et al. Discriminating mild parkinsonism: methods for epidemiological research. Mov Disord. 2001;16:33– 40
  9. 9.0 9.1 Goetz C, Poewe W, Rascol O, Sampaio C, Stebbin G. State of the Art Review: The Unified Parkinson’s Disease Rating Scale (UPDRS):Status and Recommendations. Movt. Disorders. 2013;18:7;738:750.
  10. Hauser RA, Lyons KE, Pahwa R. The UPDRS-8: a brief clinical assessment scale for Parkinson's disease. Int J Neurosci. 2012 Jul;122(7):333-7. doi: 10.3109/00207454.2012.657381