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