Quantifies degree of disability in Parkinson’s disease.
Why Use
Quantifies disease severity to facilitate clinical decision-making. Tracks disease progression over time, guiding treatment adjustments and planning. Useful in clinical trials and PD research.
When to Use
Use in patients with suspected or diagnosed Parkinson disease (PD) to assess disease severity. Useful for baseline assessment and follow-up visits to monitor progression over time.
Formula
Addition of the selected points: Parameter Finding Points Bradykinesia of hands None 0 Detectable slowing of supination-pronation rate; beginning difficulty in handling tools, buttoning clothes, handwriting +1 Moderate slowing of supination-pronation rate (one or both sides); moderate impairment of hand function; handwriting greatly impaired, micrographia present +2 Severe slowing of supination-pronation rate; unable to write or button clothes; marked difficulty in handling utensils +3 Rigidity Non-detectable 0 Detectable rigidity in neck and shoulders; activation phenomenon present; mild negative resting arm rigidity (one or both) +1 Moderate rigidity (neck and shoulders); resting rigidity present if not on meds +2 Severe rigidity (neck and shoulders); resting rigidity cannot be reversed by meds +3 Posture Normal posture; head flexed forward <4” 0 Beginning poker spine; head flexed forward >5” +1 Beginning arm flexion; head flexed up ≤6”; arms raised (one or both) but still below waist +2 Onset of simian posture; head flexed forward >6”; hands elevated above waist (one or both); sharp flexion of hands; beginning interphalangeal extension; beginning flexion of knees +3 Upper extremity swing Swings both arms well 0 One arm swing definitely decreased +1 One arm fails to swing +2 Both arms fail to swing +3 Gait Steps out will with 18-30” stride, turns about effortlessly 0 Gait shortened to 12-18” stride; beginning to strike one heel; turnaround time slowing; requires several steps +1 Stride moderately shortened to 6-12”; both heels beginning to strike floor forcefully +2 Onset of shuffling gait; steps <3”; occasional stuttering-type or blocking gait; walks on toes; turns around very slowly +3 Tremor No detectable tremor 0 <1” of peak-to-peak tremor movement (limbs or head) at rest, or in either hand while walking or during finger-to-nose test +1 Maximum tremor envelope fails to exceed 4”;. severe but not constant tremor; patient retains some control of hands +2 Tremor envelope >4”; constant severe tremor; persistent while awake unless pure cerebellar type; writing and feeding self are impossible +3 Facies Normal; full animation; no stare 0 Detectable immobility; mouth closed; beginning anxiety/depression features +1 Moderate immobility; emotion breaks through at markedly increased threshold; lips parted some of the time; moderate appearance of anxiety or depression; drooling may be present +2 Frozen facies; mouth opens ≥ 0.25”; severe drooling +3 Seborrhea None 0 Increased perspiration, secretions thin +1 Obvious oiliness present, secretion much thicker +2 Marked seborrhea, entire face and head covered by thick secretions +3 Speech Clear, loud, resonant, easily understood 0 Beginning of hoarseness, loss of inflection and resonance; good volume, still easily understood +1 Moderate hoarseness/weakness; constant monotone unvaried pitch; beginning of dysarthria, hesitance, stuttering, difficult to understand +2 Marked harshness/weakness, very difficult to hear and understand +3 Self-care No impairment 0 Still provides full self-care but rate of dressing definitely impeded; able to live alone, may be employable +1 Requires help in certain critical areas; very slow in performing most activities but manages by taking much time +2 Continuously disabled; unable to dress/feed self or walk alone +3
Pearls / Pitfalls
Has fair to moderate interrater reliability in validation studies due to subjective rating components; training examiners may improve consistency. Provides limited assessment of non-motor symptoms, which are key contributors to PD severity. Should not replace a comprehensive neurologic evaluation.
Advice
Higher scores indicate worsening motor impairment and reduced quality of life. Scores can be monitored over time to guide treatment decisions, including medication adjustments or escalation, eligibility for advanced interventions (e.g., deep brain stimulation), and advanced care planning. Significant or rapid deterioration warrants further evaluation for potential medication side effects, comorbidities, or referral to specialized care (e.g., physical or occupational therapy, movement disorder specialists).
More Information
Interpretation: Score Disability 1-10 Early illness 11-20 Moderate 21-30 Severe or advanced