Unified Parkinson Disease Rating Scale - LONG POST

[Margaret Tuchman <mtuchman@xxxxxxxxxxxxx>]

Hello, All:

You will, no doubt, recognize this rating scale as the "script" we perform
during our "audition"
when visiting the neurologist.


Unified Parkinson Disease Rating Scale (UPDRS)
and Schwab and England Activities of Daily Living can be found on
Comprehensive links to online information about Parkinson's disease from
MGH/Harvard at the URL:



Unified Parkinson Disease Rating Scale (UPDRS)

The UPDRS is a rating tool to follow the longitudinal course of Parkinson's
Disease. It is made up of the 1) Mentation, Behavior, and Mood, 2) ADL and
3) Motor sections. These are evaluated by interview. Some sections require
multiple grades assigned to each extremity. A total of 199 points are
possible. 199 represents the worst (total) disability), 0--no disability.

  I.Mentation, Behavior, Mood

        Intellectual Impairment
            0-none
            1-mild (consistent forgetfulness with partial recollection of
events with no other difficulties)
            2-moderate memory loss with disorientation and moderate
difficulty handling complex problems
            3-severe memory loss with disorientation to time and often
place, severe impairment with problems
            4-severe memory loss with orientation only to person, unable to
make judgments or solve problems

        Thought Disorder
            0-none
            1-vivid dreaming
            2-"benign" hallucination with insight retained
            3-occasional to frequent hallucination or delusions without
insight, could interfere with daily activities
            4-persistent hallucination, delusions, or florid psychosis.

        Depression
            0-not present
            1-periods of sadness or guilt greater than normal, never
sustained for more than a few days or a week
            2-sustained depression for >1 week
            3-vegetative symptoms (insomnia, anorexia, abulia, weight loss)
            4-vegetative symptoms with suicidality

        Motivation/Initiative
            0-normal
            1-less of assertive, more passive
            2-loss of initiative or disinterest in elective activities
            3-loss of initiative or disinterest in day to say (routine)
activities
            4-withdrawn, complete loss of motivation

  II.Activities of Daily Living

        Speech
            0-normal
            1-mildly affected, no difficulty being understood
            2-moderately affected, may be asked to repeat
            3-severely affected, frequently asked to repeat
            4-unintelligible most of time

        Salivation
            0-normal
            1-slight but noticeable increase, may have nighttime drooling
            2-moderately excessive saliva, hay minimal drooling
            3-marked drooling

        Swallowing
            0-normal
            1-rare choking
            2-occasional choking
            3-requires soft food
            4-requires NG tube or G-tube

        Handwriting
            0-normal
            1-slightly small or slow
            2-all words small but legible
            3-severely affected, not all words legible
            4-majority illegible

        Cutting Food/Handing Utensils
            0-normal
            1-somewhat slow and clumsy but no help needed
            2-can cut most foods, some help needed
            3-food must be cut, but can feed self
            4-needs to be fed

        Dressing
            0-normal
            1-somewhat slow, no help needed
            2-occasional help with buttons or arms in sleeves
            3-considerable help required but can do something alone
            4-helpless

        Hygiene
            0-normal
            1-somewhat slow but no help needed
            2-needs help with shower or bath or very slow in hygienic care
            3-requires assistance for washing, brushing teeth, going to bathroom
            4-helpless

        Turning in Bed/ Adjusting Bed Clothes
            0-normal
            1-somewhat slow no help needed
            2-can turn alone or adjust sheets but with great difficulty
            3-san initiate but not turn or adjust alone
            4-helpless

        Falling-Unrelated to Freezing
            0-none
            1-rare falls
            2-occasional, less than one per day
            3-average of once per day
            4->1 per day

        Freezing When Walking
            0-normal
            1-rare, may have start hesitation
            2-occasional falls from freezing,
            3-frequent freezing, occasional falls
            4-frequent falls from freezin

        Walking
            0-normal
            1-mild difficulty, day drag legs or decrease arm swing
            2-moderate difficultly requires no assist
            3-severe disturbance requires assistance
            4-cannot walk at all even with assist

        Tremor
            0-absent
            1-slight and infrequent, not bothersome to patient
            2-moderate, bothersome to patient
            3-severe, interfere with many activities
            4-marked, interferes with many activities

        Sensory Complaints Related to Parkinsonism
            0-none
            1-occasionally has numbness, tingling, and mild aching
            2-frequent, but not distressing
            3-frequent painful sensation
            4-excruciating pain

 III.Motor Exam

        Speech
            0-normal
            1-slight loss of expression, diction,volume
            2-monotone, slurred but understandable, mod. impaired
            3-marked impairment, difficult to understand
            4-unintelligible

        Facial Expression
            0-Normal
            1-slight hypomymia, could be poker face
            2-slight but definite abnormal diminution in expression
            3-mod. hypomimia, lips parted some of time
            4-masked or fixed face, lips parted 1/4 of inch or more with
complete loss of expression

        Tremor at Rest

            Face
                0-absent
                1-slight and infrequent
                2-mild and present most of time
                3-moderate and present most of time
                4-marked and present most of time

            Right Upper Extremity (RUE)
                0-absent
                1-slight and infrequent
                2-mild and present most of time
                3-moderate and present most of time
                4-marked and present most of time

            LUE
                0-absent
                1-slight and infrequent
                2-mild and present most of time
                3-moderate and present most of time
                4-marked and present most of time

            RLE
                0-absent
                1-slight and infrequent
                2-mild and present most of time
                3-moderate and present most of time
                4-marked and present most of time

            LLE
                0-absent
                1-slight and infrequent
                2-mild and present most of time
                3-moderate and present most of time
                4-marked and present most of time

        Action or Postural Tremor

            RUE
                0-absent
                1-slight, present with action
                2-moderate, present with action
                3-moderate present with action and posture holding
                4-marked, interferes with feeding

            LUE
                0-absent
                1-slight, present with action
                2-moderate, present with action
                3-moderate present with action and posture holding
                4-marked, interferes with feeding

        Rigidity

            Neck
                0-absent
                1-slight or only with activation
                2-mild/moderate
                3-marked, full range of motion
                4-severe

            RUE
                0-absent
                1-slight or only with activation
                2-mild/moderate
                3-marked, full range of motion
                4-severe

            LUE
                0-absent
                1-slight or only with activation
                2-mild/moderate
                3-marked, full range of motion
                4-severe

            RLE
                0-absent
                1-slight or only with activation
                2-mild/moderate
                3-marked, full range of motion
                4-severe

            LLE
                0-absent
                1-slight or only with activation
                2-mild/moderate
                3-marked, full range of motion
                4-severe

        Finger taps

            Right
                0-normal
                1-mild slowing, and/or reduction in amp.
                2-moderate impaired. Definite and early fatiguing, may have
occasional arrests
                3-severely impaired. Frequent hesitations and arrests.
                4-can barely perform

            Left
                0-normal
                1-mild slowing, and/or reduction in amp.
                2-moderate impaired. Definite and early fatiguing, may have
occasional arrests
                3-severely impaired. Frequent hesitations and arrests.
                4-can barely perform

        Hand Movements (open and close hands in rapid succession)

            Right
                0-normal
                1-mild slowing, and/or reduction in amp.
                2-moderate impaired. Definite and early fatiguing, may have
occasional arrests
                3-severely impaired. Frequent hesitations and arrests.
                4-can barely perform

            Left
                0-normal
                1-mild slowing, and/or reduction in amp.
                2-moderate impaired. Definite and early fatiguing, may have
occasional arrests
                3-severely impaired. Frequent hesitations and arrests.
                4-can barely perform

        Rapid Alternating Movements (pronate and supinate hands)

            Right
                0-normal
                1-mild slowing, and/or reduction in amp.
                2-moderate impaired. Definite and early fatiguing, may have
occasional arrests
                3-severely impaired. Frequent hesitations and arrests.
                4-can barely perform

            Left
                0-normal
                1-mild slowing, and/or reduction in amp.
                2-moderate impaired. Definite and early fatiguing, may have
occasional arrests
                3-severely impaired. Frequent hesitations and arrests.
                4-can barely perform

        Leg Agility (tap heel on ground, amp should be 3 inches)

            Right
                0-normal
                1-mild slowing, and/or reduction in amp.
                2-moderate impaired. Definite and early fatiguing, may have
occasional arrests
                3-severely impaired. Frequent hesitations and arrests.
                4-can barely perform

            Left
                0-normal
                1-mild slowing, and/or reduction in amp.
                2-moderate impaired. Definite and early fatiguing, may have
occasional arrests
                3-severely impaired. Frequent hesitations and arrests.
                4-can barely perform

        Arising From Chair (pt. arises with arms folded across chest)
            0-normal
            1-slow, may need more than one attempt
            2-pushes self up from arms or seat
            3-tends to fall back, may need multiple tries but can arise
without assistance
            4-unable to arise without help

        Posture
            0-normal erect
            1-slightly stooped, could be normal for older person
            2-definitely abnormal, mod. stooped, may lean to one side
            3-severely stooped with kyphosis
            4-marked flexion with extreme abnormality of posture

        Gait
            0-normal
            1-walks slowly, may shuffle with short steps, no festination or
propulsion
            2-walks with difficulty, little or no assistance, some
festination, short steps or propulsion
            3-severe disturbance, frequent assistance
            4-cannot walk

        Postural Stability (retropulsion test)
            0-normal
            1-recovers unaided
            2-would fall if not caught
            3-falls spontaneously
            4-unable to stand

        Body Bradykinesia/ Hypokinesia
            0-none
            1-minimal slowness, could be normal, deliberate character
            2-mild slowness and poverty of movement, definitely abnormal, or
dec. amp. of movement
            3-moderate slowness, poverty, or small amplitude
            4-marked slowness, poverty, or amplitude

Margaret Tuchman (55yrs, Dx 1980)- NJ-08540
mtuchman@xxxxxxxxxxxxx