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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
) !entation" #eha$ior" and !ood" %) &D' and () !otor sections. These are e$aluated )* inter$iew. Some
sections re+uire multiple grades assigned to each e,tremit*. & total of -- points are possi)le. --
represents the worst (total) disa)ilit*)" .//no disa)ilit*.
I. Mentation, Behavior, Mood
o Intellectual Impairment
./none
/mild (consistent forgetfulness with partial recollection of e$ents with no other difficulties)
%/moderate memor* loss with disorientation and moderate difficult* handling comple, pro)lems
(/se$ere memor* loss with disorientation to time and often place" se$ere impairment with
pro)lems
0/se$ere memor* loss with orientation onl* to person" una)le to make 1udgments or sol$e
pro)lems
o Thought Disorder
./none
/$i$id dreaming
%/2)enign2 hallucination with insight retained
(/occasional to fre+uent hallucination or delusions without insight" could interfere with dail*
acti$ities
0/persistent hallucination" delusions" or florid ps*chosis.
o Depression
./not present
/periods of sadness or guilt greater than normal" ne$er sustained for more than a few da*s or a
week
%/sustained depression for 3 week
(/$egetati$e s*mptoms (insomnia" anore,ia" a)ulia" weight loss)
0/$egetati$e s*mptoms with suicidalit*
o Motivation/Initiative
./normal
/less of asserti$e" more passi$e
%/loss of initiati$e or disinterest in electi$e acti$ities
(/loss of initiati$e or disinterest in da* to sa* (routine) acti$ities
0/withdrawn" complete loss of moti$ation
II. Activities of Daily Living
o Speech
./normal
/mildl* affected" no difficult* )eing understood
%/moderatel* affected" ma* )e asked to repeat
(/se$erel* affected" fre+uentl* asked to repeat
0/unintelligi)le most of time
o Salivation
./normal
/slight )ut noticea)le increase" ma* ha$e nighttime drooling
%/moderatel* e,cessi$e sali$a" ha* minimal drooling
(/marked drooling
o Swallowing
./normal
/rare choking
%/occasional choking
(/re+uires soft food
0/re+uires 45 tu)e or 5/tu)e
o andwriting
./normal
/slightl* small or slow
%/all words small )ut legi)le
(/se$erel* affected" not all words legi)le
0/ma1orit* illegi)le
o !utting "ood/anding #tensils
./normal
/somewhat slow and clums* )ut no help needed
%/can cut most foods" some help needed
(/food must )e cut" )ut can feed self
0/needs to )e fed
o Dressing
./normal
/somewhat slow" no help needed
%/occasional help with )uttons or arms in slee$es
(/considera)le help re+uired )ut can do something alone
0/helpless
o ygiene
./normal
/somewhat slow )ut no help needed
%/needs help with shower or )ath or $er* slow in h*gienic care
(/re+uires assistance for washing" )rushing teeth" going to )athroom
0/helpless
o Turning in Bed/ Ad$usting Bed !lothes
./normal
/somewhat slow no help needed
%/can turn alone or ad1ust sheets )ut with great difficult*
(/san initiate )ut not turn or ad1ust alone
0/helpless
o "alling%#nrelated to "ree&ing
./none
/rare falls
%/occasional" less than one per da*
(/a$erage of once per da*
0/3 per da*
o "ree&ing 'hen 'al(ing
./normal
/rare" ma* ha$e start hesitation
%/occasional falls from free6ing"
(/fre+uent free6ing" occasional falls
0/fre+uent falls from free6in
o 'al(ing
./normal
/mild difficult*" da* drag legs or decrease arm swing
%/moderate difficultl* re+uires no assist
(/se$ere distur)ance re+uires assistance
0/cannot walk at all e$en with assist
o Tremor
./a)sent
/slight and infre+uent" not )othersome to patient
%/moderate" )othersome to patient
(/se$ere" interfere with man* acti$ities
0/marked" interferes with man* acti$ities
o Sensory !omplaints )elated to *ar(insonism
./none
/occasionall* has num)ness" tingling" and mild aching
%/fre+uent" )ut not distressing
(/fre+uent painful sensation
0/e,cruciating pain
III. Motor +,am
o Speech
./normal
/slight loss of e,pression" diction"$olume
%/monotone" slurred )ut understanda)le" mod. impaired
(/marked impairment" difficult to understand
0/unintelligi)le
o "acial +,pression
./4ormal
/slight h*pom*mia" could )e poker face
%/slight )ut definite a)normal diminution in e,pression
(/mod. h*pomimia" lips parted some of time
0/masked or fi,ed face" lips parted 70 of inch or more with complete loss of e,pression
o Tremor at )est
"ace
./a)sent
/slight and infre+uent
%/mild and present most of time
(/moderate and present most of time
0/marked and present most of time
)ight #pper +,tremity -)#+.
./a)sent
/slight and infre+uent
%/mild and present most of time
(/moderate and present most of time
0/marked and present most of time
L#+
./a)sent
/slight and infre+uent
%/mild and present most of time
(/moderate and present most of time
0/marked and present most of time
)L+
./a)sent
/slight and infre+uent
%/mild and present most of time
(/moderate and present most of time
0/marked and present most of time
LL+
./a)sent
/slight and infre+uent
%/mild and present most of time
(/moderate and present most of time
0/marked and present most of time
o Action or *ostural Tremor
)#+
./a)sent
/slight" present with action
%/moderate" present with action
(/moderate present with action and posture holding
0/marked" interferes with feeding
L#+
./a)sent
/slight" present with action
%/moderate" present with action
(/moderate present with action and posture holding
0/marked" interferes with feeding
o )igidity
/ec(
./a)sent
/slight or onl* with acti$ation
%/mild7moderate
(/marked" full range of motion
0/se$ere
)#+
./a)sent
/slight or onl* with acti$ation
%/mild7moderate
(/marked" full range of motion
0/se$ere
L#+
./a)sent
/slight or onl* with acti$ation
%/mild7moderate
(/marked" full range of motion
0/se$ere
)L+
./a)sent
/slight or onl* with acti$ation
%/mild7moderate
(/marked" full range of motion
0/se$ere
LL+
./a)sent
/slight or onl* with acti$ation
%/mild7moderate
(/marked" full range of motion
0/se$ere
o "inger taps
)ight
./normal
/mild slowing" and7or reduction in amp.
%/moderate impaired. Definite and earl* fatiguing" ma* ha$e occasional arrests
(/se$erel* impaired. 8re+uent hesitations and arrests.
0/can )arel* perform
Left
./normal
/mild slowing" and7or reduction in amp.
%/moderate impaired. Definite and earl* fatiguing" ma* ha$e occasional arrests
(/se$erel* impaired. 8re+uent hesitations and arrests.
0/can )arel* perform
o and Movements -open and close hands in rapid succession.
)ight
./normal
/mild slowing" and7or reduction in amp.
%/moderate impaired. Definite and earl* fatiguing" ma* ha$e occasional arrests
(/se$erel* impaired. 8re+uent hesitations and arrests.
0/can )arel* perform
Left
./normal
/mild slowing" and7or reduction in amp.
%/moderate impaired. Definite and earl* fatiguing" ma* ha$e occasional arrests
(/se$erel* impaired. 8re+uent hesitations and arrests.
0/can )arel* perform
o )apid Alternating Movements -pronate and supinate hands.
)ight
./normal
/mild slowing" and7or reduction in amp.
%/moderate impaired. Definite and earl* fatiguing" ma* ha$e occasional arrests
(/se$erel* impaired. 8re+uent hesitations and arrests.
0/can )arel* perform
Left
./normal
/mild slowing" and7or reduction in amp.
%/moderate impaired. Definite and earl* fatiguing" ma* ha$e occasional arrests
(/se$erel* impaired. 8re+uent hesitations and arrests.
0/can )arel* perform
o Leg Agility -tap heel on ground, amp should 0e 1 inches.
)ight
./normal
/mild slowing" and7or reduction in amp.
%/moderate impaired. Definite and earl* fatiguing" ma* ha$e occasional arrests
(/se$erel* impaired. 8re+uent hesitations and arrests.
0/can )arel* perform
Left
./normal
/mild slowing" and7or reduction in amp.
%/moderate impaired. Definite and earl* fatiguing" ma* ha$e occasional arrests
(/se$erel* impaired. 8re+uent hesitations and arrests.
0/can )arel* perform
o Arising "rom !hair -pt2 arises with arms folded across chest.
./normal
/slow" ma* need more than one attempt
%/pushes self up from arms or seat
(/tends to fall )ack" ma* need multiple tries )ut can arise without assistance
0/una)le to arise without help
o *osture
./normal erect
/slightl* stooped" could )e normal for older person
%/definitel* a)normal" mod. stooped" ma* lean to one side
(/se$erel* stooped with k*phosis
0/marked fle,ion with e,treme a)normalit* of posture
o 3ait
./normal
/walks slowl*" ma* shuffle with short steps" no festination or propulsion
%/walks with difficult*" little or no assistance" some festination" short steps or propulsion
(/se$ere distur)ance" fre+uent assistance
0/cannot walk
o *ostural Sta0ility -retropulsion test.
./normal
/reco$ers unaided
%/would fall if not caught
(/falls spontaneousl*
0/una)le to stand
o Body Brady(inesia/ ypo(inesia
./none
/minimal slowness" could )e normal" deli)erate character
%/mild slowness and po$ert* of mo$ement" definitel* a)normal" or dec. amp. of mo$ement
(/moderate slowness" po$ert*" or small amplitude
0/marked slowness" po$ert*" or amplitude

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