Summary

What it measures:

UPDRS and MDS-UPDRS are tools to measure the severity and progression of Parkinson disease (PD). (1,2) The UPDRS was developed in 1987 as a gold standard by neurologists for monitoring the response to medications used to decrease the signs and symptoms of PD. These tools are used for patients diagnosed with idiopathic PD of any stage, according to the Hoehn and Yahr Staging Scale (H&Y). (1)

Both versions contain 4 parts. For either version, the 4 parts can be summed or analyzed individually. (1,2)

UPDRS: 4 parts (1)

• Part I: Mentation, Behavior, Mood
• Part II: Activities of Daily Living (Determine for “on” or “off”, indicating either a “good” or “bad” day, respectively.)
• Part III: Motor Examination
• Part IV: Complications of Therapy (in the past week)
• Part V: H&Y staging scale
• Part VI: S&E ADL scale

Parts I to III are scored on a 0-4 rating scale. Part IV is scored with yes and no ratings. Higher scores indicate increased severity.

Once the first 4 parts are completed, the administrator can then complete the H&Y staging scale and the Schwab and England Activities of Daily Living Scale (S&E ADL scale).

The MDS-UPDRS was created in 2007. The revision board took aspects of nonmotor functioning out of each subcategory listed below and renamed the first part “Non-Motor Experiences of Daily Living.” Part II of the modified test is identical to the second part of the original, but has been renamed “Motor Experiences of Daily Living” to separate it from the new title of Part I. Part IV has been condensed to include only "Motor Complications." (2)

MDS-UPDRS: 4 parts (2)

• Part I: Non-Motor Experiences of Daily Living
• Part II: Motor Experiences of Daily Living
• Part III: Motor Examination
• Part IV: Motor Complications
• Part V: Modified Hoehn and Yahr Staging
• Part VI: Modified Schwab and England Activities on Daily Living Scale

Reason for modification:

The Movement Disorder Society believed that the yes and no part of the original UPDRS examination altered the scoring of the scale because the rest of the scale used a 0-4 rating scale. The society changed all items to a 0-4 rating scale to make the test have a "more consistent anchor." (2) UPDRS also emphasized severe disabilities and impairments, while MDS-UPDRS helps to "differentiate" between slight and mild deficits. (2) MDS-UPDRS was also revised so that the questions are on a seventh grade reading level to ensure patient understanding. MDS-UPDRS specifies who is taking the exam: caretaker or patient. The Movement Disorder Society adapted the original to be more culturally sensitive to ensure the rating scale focuses on experiences more so than the tasks at hand. (2,3)

Conditions & Test Variations Included in this Summary:

This summary contains information on the use of the UPDRS and MDS-UPDRS in patients or clients with PD.

Target Population:

People with Parkinson disease

Taskforce Recommendations

APTA states that the MDS-UPDRS can be used to classify people with PD based on whether the condition is postural instability and gait disorder predominant, tremor predominant, or mixed. According to APTA, MDS-UPDRS motor exam, MDS-UPDRS nonmotor exam, and MDS-UPDRS ADLs are outcome measures for recommended use by the PDEDGE task force. APTA explains that the extent of bradykinesia, tremor, and rigidity can be measured using MDS-UPDRS motor exam. (39) The International Parkinson and Movement Disorder Society (MDS) recommends the MDS-UPDRS as a rating scale to use for PD. (40)

Clinical Insights

UPDRS and MDS-UPDRS can be used in the inpatient, outpatient, or home setting. This measure can classify patients with PD based on what impairments are predominant in the disease presentation. (1,2)