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| Hoehn and Yahr Staging of Parkinson's Disease | |||||||||||
| Stage | Descriptions | ||||||||||
| 1 |
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| 2 |
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| 3 |
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| 4 |
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| 5 |
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| Unified Parkinson Disease Rating Scale (UPDRS) | ||
| Patient Name: | ||
| Date: | ||
| I. Mentation, Behavior, Mood | ||
| 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 |
|
| 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. |
|
| Depression | 0-not present 1-periods of sadness or guilt greater than normal, never sustained for more than a few days or a week 2-sustained depression for >1 week 3-vegetative symptoms (insomnia, anorexia, abulia, weight loss) 4-vegetative symptoms with suicidal ideas |
|
| 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or disinterest in elective activities 3-loss of initiative or disinterest in day to say (routine) activities 4-withdrawn, complete loss of motivation |
|
| II. Activities of Daily Living | ||
| 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 |
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| Salivation | 0-normal 1-slight but noticeable increase, may have nighttime drooling 2-moderately excessive saliva, hay minimal drooling 3-marked drooling |
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| Swallowing | 0-normal 1-rare choking 2-occasional choking 3-requires soft food 4-requires NG tube or G-tube |
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| Handwriting | 0-normal 1-slightly small or slow 2-all words small but legible 3-severely affected, not all words legible 4-majority illegible |
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| 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 |
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| 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 something alone 4-helpless |
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| 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 |
|
| 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-san initiate but not turn or adjust alone 4-helpless |
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| Falling - Unrelated to Freezing |
0-none 1-rare falls 2-occasional, less than one per day 3-average of once per day 4->1 per day |
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| 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 |
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| Walking | 0-normal 1-mild difficulty, day drag legs or decrease arm swing 2-moderate difficulty requires no assist 3-severe disturbance requires assistance 4-cannot walk at all even with assist |
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| Tremor | 0-absent 1-slight and infrequent, not bothersome to patient 2-moderate, bothersome to patient 3-severe, interfere with many activities 4-marked, interferes with many activities |
|
| Sensory Complaints Related to Parkinson | 0-none 1-occasionally has numbness, tingling, and mild aching 2-frequent, but not distressing 3-frequent painful sensation 4-excruciating pain |
|
| III. Motor Exam | ||
| Speech | 0-normal 1-slight loss of expression, diction,volume 2-monotone, slurred but understandable, mod. impaired 3-marked impairment, difficult to understand 4-unintelligible |
|
| Facial Expression |
0-Normal 1-slight hypomymia, could be poker face 2-slight but definite abnormal diminution in expression 3-mod. hypomymia, lips parted some of time 4-masked or fixed face, lips parted 1/4 of inch or more with complete loss of expression |
|
| Tremor at Rest | ||
| 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 |
|
| 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 |
|
| LUE | same as above | |
| RLE | same as above | |
| LLE | same as above | |
| Action or Postural Tremor | ||
| 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 |
|
| LUE | same as above | |
| Rigidity | ||
| Neck | 0-absent 1-slight or only with activation 2-mild/moderate 3-marked, full range of motion 4-severe |
|
| RUE | 0-absent 1-slight or only with activation 2-mild/moderate 3-marked, full range of motion 4-severe |
|
| LUE | same as above | |
| RLE | same as above | |
| LLE | same as above | |
| Finger taps | ||
| 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 |
|
| 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 |
|
| Hand Movements (open and close hands in rapid succession) | ||
| 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 |
|
| Left | Same as above | |
| Rapid Alternating Movements (pronate and supinate hands) | ||
| 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 |
|
| Left | same as above | |
| Leg Agility (tap heel on ground, amp should be 3 inches) | ||
| 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 |
|
| Left | same as above | |
| 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 |
|
| 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 |
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| 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 |
|
| Postural Stability (retro-
pulsion test) |
0-normal 1-recovers unaided 2-would fall if not caught 3-falls spontaneously 4-unable to stand |
|
| Body Brady- kinesia / Hypokinesia |
0-none 1-minimal slowness, could be normal, deliberate character 2-mild slowness and poverty of movement, definitely abnormal, or dec. amp. of movement 3-moderate slowness, poverty, or small amplitude 4-marked slowness, poverty, or amplitude |
|
| Total Score: | ||
| Score: 0 no disability, 199 is worst. | ||
