The Unified Parkinson’s Disease Rating Scale (UPDRS) is the most widely used clinical rating scale for Parkinson’s disease (PD) regardless of severity, medication treatment, or age. A comprehensive question assessment of both motor and non-motor symptoms associated with Parkinson’s was originally developed in the 1980s.

For clinical trials, the UPDRS has been widely used to follow the longitudinal course of the disease and determine the treatment-related benefits. Other less frequently used rating scales for Parkinson’s disease include the Hoehn and Yahr scale and Schwab and England activities of daily living scale.

Components

The UPDRS is made up of self-evaluation of the activities of daily life (ADLs), evaluation of mentation, behavior, and mood and complications of therapy. A score of 199 on the UPDRS scale represents the worst while a score of zero represents no disability. Interview or/and clinical observation evaluate different components of the scale.

The scale commonly assesses:

• The patients’ perceptions of their ability to carry out activities of daily living, including dressing, walking, eating, handwriting, hygiene, falling, salivating, turning in bed and cutting food.
• Rating(s) for tremor, slowness (Bradykinesia), muscle stiffness (rigidity), and balance.
• Behavioral problems such as intellectual decline, hallucinations, and depression.
• Rating(s) of involuntary movements, painful cramps (Dystonia), and irregular medication responses also known as motor fluctuations.

The original UPDR scale consisted only 3 segments – ‘Mentation, Behavior, and Mood’, ‘ADL’ and ‘Motor’ sections. However, later on, Modified Hoehn and Yahr Scale and Schwab and England ADL scale were included for better accuracy.