Unified Parkinson's Disease Rating Scale (UPDRS)

Assesses signs and symptoms of Parkinson’s disease as part of diagnosis and progression monitoring.

Refer to the text below the calculator for more information about the UPDRS and its scoring.


The Unified Parkinson's Disease Rating Scale (UPDRS) is a rating tool that includes series of ratings for typical Parkinson’s symptoms which result in the movement hindrances of this disease.

The UPDRS consist of four sections:

  • Mentation, Behavior And Mood
  • Activities Of Daily Living (for both “on” and “off”)
  • Motor Examination
  • Complications Of Therapy (In the past week)

The Hoehn and Yahr Staging and Schwab and England Activities of Daily Living Scale are also included.


The UPDRS scoring consists of 4 subscores of its sections, an overall score and 2 results of the scales:

  • UPDRS score – points scored out of 199 possible, which are grouped in four sections:

I. Mentation, Behavior And Mood;

II. Activities Of Daily Living (for both “on” and “off”);

III. Motor Examination;

IV. Complications Of Therapy (In the past week).

  • The Hoehn and Yahr Staging – stage 0 to stage 5;
  • Schwab and England Activities of Daily Living Scale – 0 to 100%.

I

Mentation, Behavior And Mood

1

Intellectual Impairment

2

Thought Disorder (Due to dementia or drug intoxication)

3

Depression

4

Motivation/Initiative

II

Activities Of Daily Living (for both “on” and “off”)

5

Speech

6

Salivation

7

Swallowing

8

Handwriting

9

Cutting food and handling utensils

10

Dressing

11

Hygiene

12

Turning in bed and adjusting bed clothes

13

Falling (unrelated to freezing)

14

Freezing when walking

15

Walking

16

Tremor (Symptomatic complaint of tremor in any part of body.)

17

Sensory complaints related to parkinsonism

III

Motor Examination

18

Speech

19

Facial Expression

20a

Tremor at rest (Head: face, lips, chin)

20b

Tremor at rest (Right hand)

20c

Tremor at rest (Left hand)

20d

Tremor at rest (Right leg)

20e

Tremor at rest (Left leg)

21a

Action or Postural Tremor (Right hand)

21b

Action or Postural Tremor (Left hand)

22a

Rigidity (Neck)

(Judged on passive movement of major joints with patient relaxed in sitting position. Cogwheeling to be ignored.)
22b

Rigidity (Right hand)

22c

Rigidity (Left hand)

22d

Rigidity (Right leg)

22e

Rigidity (Left leg)

23a

Finger Taps (Right hand)

(Patient taps thumb with index finger in rapid succession.)
23b

Finger Taps (Left hand)

(Patient taps thumb with index finger in rapid succession.)
24a

Hand Movements (Right hand)

(Patient opens and closes hands in rapid succession.)
24b

Hand Movements (Left hand)

(Patient opens and closes hands in rapid succession.)
25a

Rapid Alternating Movements of Hands (Right hand)

(Pronation-supination movements of hands, vertically and horizontally, with as large an amplitude as possible, both hands simultaneously.)
25b

Rapid Alternating Movements of Hands (Left hand)

(Pronation-supination movements of hands, vertically and horizontally, with as large an amplitude as possible, both hands simultaneously.)
26a

Leg Agility (Right leg)

(Patient taps heel on the ground in rapid succession picking up entire leg. Amplitude should be at least 3 inches.)
26b

Leg Agility (Left leg)

(Patient taps heel on the ground in rapid succession picking up entire leg. Amplitude should be at least 3 inches.)
27

Arising from Chair

(Patient attempts to rise from a straight-backed chair, with arms folded across chest.)
28

Posture

29

Gait

30

Postural Stability

(Response to sudden, strong posterior displacement produced by pull on shoulders while patient erect with eyes open and feet slightly apart. Patient is prepared.)
31

Body Bradykinesia and Hypokinesia

(Combining slowness, hesitancy, decreased armswing, small amplitude, and poverty of movement in general.)
IV

Complications Of Therapy (In the past week)

A. Dyskinesias

32

Duration: What proportion of the waking day are dyskinesias present?

(Historical information.)
33

Disability: How disabling are the dyskinesias?

(Historical information; may be modified by office examination.)
34

Painful Dyskinesias: How painful are the dyskinesias?

35

Presence of Early Morning Dystonia

(Historical information.)

B. Clinical Fluctuations

36

Are “off” periods predictable?

37

Are “off” periods unpredictable?

38

Do “off” periods come on suddenly, within a few seconds?

39

What proportion of the waking day is the patient “off” on average?

C. Other Complications

40

Does the patient have anorexia, nausea, or vomiting?

41

Any sleep disturbances, such as insomnia or hypersomnolence?

42

Does the patient have symptomatic orthostasis?

(Record the patient’s blood pressure, height and weight on the scoring form)
V

Modified Hoehn And Yahr Staging

VI

Schwab And England Activities Of Daily Living Scale

  Embed  Print  Share 

Send Us Your Feedback

Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.


 

Unified Parkinson's Disease Rating Scale Explained

The Unified Parkinson's Disease Rating Scale (UPDRS) is a rating tool that includes series of ratings for typical Parkinson’s symptoms which result in the movement hindrances of this disease.

The UPDRS consist of four sections:

  • I. Mentation, Behavior And Mood
  • II. Activities Of Daily Living (for both “on” and “off”)
  • III. Motor Examination
  • IV. Complications Of Therapy (In the past week)

The Hoehn and Yahr Staging and Schwab and England Activities of Daily Living Scale are also included.

The UPDRS is administered by interview and clinical observation, with some items requiring multiple grades for each extremity.

The UPDRS was originally published in 1987 and is still one of the most commonly used tools for following the longitudinal course of Parkinson’s disease. A modified version, sponsored by the Movement Disorders Society, the MDS-UPDRS was published in 2007 as a copyrighted tool at a cost.

UPDRS scoring

The UPDRS scoring consists of 4 subscores of its sections, an overall score and 2 results of the scales:

UPDRS result Scoring
UPDRS score (42 items) Points out of 199
I. Mentation, Behavior And Mood (items 1 – 4) Points out of 16
II. Activities Of Daily Living (items 5 – 17) Points out of 52
III. Motor Examination (items 18 – 31) Points out of 108
IV. Complications Of Therapy (32 – 42) Points out of 23
The Hoehn and Yahr Staging Stages 0 to 5
Schwab and England Activities of Daily Living Scale 0 to 100%

The lowest score on the overall UPDRS is 0, indicating an absence of signs and symptoms of Parkinson's disease, whilst the highest score is 199, indicating most severe level of disability due to Parkinson’s.

 

References

Original reference

Fahn S, Elton R, Members of the UPDRS Development Committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds. Recent Developments in Parkinson’s Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, pp 15 3-163, 293-304.

Validation

Ramaker C, Marinus J, Stiggelbout AM, Van Hilten BJ. Systematic evaluation of rating scales for impairment and disability in Parkinson's disease. Mov Disord. 2002; 17(5):867-876.

Other references

Goetz CG, Tilley BC, Shaftman SR, et al. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008; 23(15):2129-2170.


Specialty: Neurology

Objective: Assessment

Year Of Study: 1987

Abbreviation: UPDRS

Article By: Denise Nedea

Published On: July 23, 2020 · 12:00 AM

Last Checked: July 23, 2020

Next Review: July 23, 2025