sailor girlStages of Parkinson's Disease

This article is excerpted from the APDA's booklet, Coping With Parkinson's Disease

The following scale, developed by Hoehn and Yahr, is the most widely used one to describe PD:

    1. Stage One
    2. Signs and symptoms on one side only
    3. Symptoms mild
    4. Symptoms inconvenient but not disabling
    5. Usually presents with tremor of one limb
    6. Friends have noticed changes in posture, locomotion and facial expression
  1. Stage Two
    1. Symptoms are bilateral
    2. Minimal disability
    3. Posture and gait affected
  2. Stage Three
    1. Significant slowing of body movements
    2. Early impairment of equilibrium on walking or standing
    3. Generalized dysfunction that is moderately severe
  3. Stage Four
    1. Severe symptoms
    2. Can still walk to a limited extent
    3. Rigidity and bradykinesia
    4. No longer able to live alone
    5. Tremor may be less than earlier stages
  4. Stage Five
    1. Cachectic stage
    2. Invalidism complete
    3. Cannot stand or walk
    4. Requires constant nursing care

This rating system has been largely supplanted by the Unified Parkinson's Disease Rating Scale, which is much more complicated.

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.

  1. Mentation, Behavior, Mood
  1. Activities of Daily Living
  2. Motor Exam

Schwab and England Activities of Daily Living

Gillingham FJ, Donaldson MC, eds., Third Symp. of Parkinson's Disease, Edinburgh, Scotland, E&S Livingstone, 1969, pp.152-7.

Rating can be assigned by rater or by patient.


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