hi jonathan

you wrote:
>Do you know or anyone else where a copy of the
>Unified Parkinson's Disease Rating Scale, can be obtained?

the updrs as well as two other commonly used rating scales
are available at:
Parkinson's Disease Staging
http://neurosurgery.mgh.harvard.edu/pdstages.htm

in addition, a search of our mailing list archives on the web
using UPDRS as the search criterion
produced several "hits" going back to 1995

for those without web access
i have reproduced the UPDRS below

janet

a new voice: http://www.newcountry.nu/pd/members/janet/index.htm
pwp event calendar: http://newww.com/cgi-bin/do_cal?c:pwpc
51/10 - endocarb/selegiline/fluoxetine - [log in to unmask]
janet paterson

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Unified Parkinson Disease Rating Scale (UPDRS)
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The UPDRS is a rating tool to follow the longitudinal course of Parkinson's
Disease. It is made up of three sections: 1) Mentation, Behavior, and Mood,
2) Activities of Daily Living, 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
----------------------------------------------

a. 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

b. 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.

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

d. 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 day (routine) activities
4-withdrawn, complete loss of motivation


----------------------------------------------
2. Activities of Daily Living
----------------------------------------------

a. 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

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

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

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

e. 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

f. 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 some things alone
4-helpless

g. 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

h. 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-can initiate but not turn or adjust alone
4-helpless

i. Falling-Unrelated to Freezing
0-none
1-rare falls
2-less than one per day
3-average of once per day
4-more than one per day

j. 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 freezing

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

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

m. 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


----------------------------------------------
3. Motor Exam
----------------------------------------------

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

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

c. Tremor at Rest

1. 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

2. 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

3. 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

4. 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

5. 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

d. Action or Postural Tremor

1. 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

2. 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

e. Rigidity

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

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

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

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

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

f. Finger taps

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

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

g. Hand Movements (open and close hands in rapid succession)

1. 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

2. 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

h. Rapid Alternating Movements (pronate and supinate hands)

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

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

i. Leg Agility (tap heel on ground, amplitude should be 3 inches)

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

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

j. Arising From Chair (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

k. 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

l. 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

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

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

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MGH/Harvard at the URL:
http://neurosurgery.mgh.harvard.edu/pdstages.htm