The Unified Parkinson's disease rating scale (UPDRS)
Webster developed a rating scale for patients with Parkinson's disease based
on 10 clinical findings. The scale indicates the severity of disease and the
clinical impairment. Changes in the scale over time can reflect changes due
to disease progression or therapeutic interventions.
Parameters:
- Bradykinesia of hands (including and writing)
- Rigidity
- Posture
- Upper extremity swing
- Gait
- Tremor
- Facies
- Seborrhea
- Speech
- Self-care
| Parameter |
Finding |
Points |
| Bradykinesia of hands |
No involvement |
0 |
Detectable slowing of the supination-pronation rate;
beginning difficulty in handling tools, buttoning clothes, and with
handwriting |
1 |
Moderate slowing of the supination-pronation rate in
one or both sides; moderate impairment of hand function; handwriting
is greatly impaired, micrographia present |
2 |
Severe slowing of the supination-pronation rate; unable
to write or button clothes; marked difficulty in handling utensils |
3 |
Rigidity |
Non-detectable |
0 |
Detectable rigidity in neck and shoulders; activation
phenomenon is present; one or both arms show mild, negative, resting
rigidity |
1 |
Moderate rigidity in neck and shoulders; resting rigidity
is present if patient is not on medications |
2 |
Severe rigidity in neck and shoulders; resting rigidity
cannot be reversed by medication |
3 |
| Posture |
Normal posture; head flexed forward less than 4 inches |
0 |
Beginning poker spine; head flexed forward more than
5 inches |
1 |
Beginning arm flexion; head flexed forward up to 6
inches; one or both arms raised but still below waist |
2 |
Onset of simian posture; head flexed forward more than
6 inches; one or both hands elevated above the waist; sharp flexion
of hands, beginning interphalangeal extension; beginning flexion of
knees |
3 |
| Upper
extremity swing |
Swings both arms well |
0 |
One arm definitely decreased in amount of swing |
1 |
One arm fails to swing |
2 |
Both arms fail to swing |
3 |
| Gait |
Steps out well with 18-30 inch stride; turns about
effortlessly |
0 |
Gait shortened to 12-18 inch stride; beginning to strike
one heel; turn around time slowing; requires several steps |
1 |
Stride moderately shortened to 6-12 inches; both heels
beginning to strike floor forcefully |
2 |
Onset of shuffling gait; steps less than 3 inches;
occasional stuttering-type or blocking gait; walks on toes; turns around
very slowly |
3 |
| Tremor |
No detectable tremor found |
0 |
Less than 1 inch of peak-to-peak tremor movement observed
in limbs or head at rest, or in either hand while walking or during
the finger-to-nose testing |
1 |
Maximum tremor envelope fails to exceed 4 inches; tremor
is severe but not constant and patient retains some control of hands |
2 |
Tremor envelope exceeds 4 inches; tremor is constant
and severe; patient cannot get free of tremor while awake unless it
is a pure cerebelar type; writing and feeding self are impossible |
3 |
| Facies |
normal; full animation; no stare |
0 |
detectable immobility; mouth remains closed; beginning
features of anxiety or depression |
1 |
moderate immobility; emotion breaks through at markedly
increased threshold; lips parted some of the time; moderate appearance
of anxiety or depression; drooling may be present |
2 |
Frozen facies; mouth opens >= 0.25 inches; drooling
may be severe |
3 |
| Seborrhea |
None |
0 |
Increased perspiration, secretions remain thin |
1 |
Obvious oiliness present and secretion much thicker |
2 |
Marked seborrhea; entire face and head covered by thick
secretion |
3 |
| Speech |
Clear, loud, resonant, easily understood |
0 |
Beginning of hoarseness, with loss of inflection and
resonance; good volume and still easily understood |
1 |
Moderate hoarseness and weakness; constant monotone,
unvaried pitch; beginning of dysarthria, hesitance, stuttering, difficult
to understand. |
2 |
Marked harshness and weakness; very difficult to hear
and to understand |
3 |
| Self-care |
No impairment |
0 |
Still provides full self-care, but rate of dressing
definitely impeded; able to live alone and may be employable |
1 |
Requires help in certain critical areas; very slow
in performing most activities but manages by taking much time |
2 |
Continuously disabled; unable to dress, feed self or
walk alone |
3 |
Parkinson’s disease rating scale = SUM (points for all 10 parameters).
Interpretation:
Minimum score: 0
Maximum score: 30
The higher the score the greater the disease severity and disability.
| Scale |
Disability |
1 − 10 |
Early illness |
11 - 20 |
Moderate |
21 − 30 |
Severe or advanced |
