Understanding Parkinson's Disease

Scales and scores for assessing Parkinson's disease symptoms in clinical research

These scales and scores are used to assess severity, motor symptoms,
non-motor symptoms and daily life activities


Beck Depression Inventory (BDI or BDI-II)

The BDI is a 21-question multiple-choice self-report inventory used for measuring the severity of depression. The latest version (BDI-II) was published in 19961

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

The DSM-IV is the fourth edition of a comprehensive classification of diagnostic criteria of mental disorders published by the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders; APA, 1994). Items I and II refer to specific diagnostic criteria for depression as defined in Diagnostic and Statistical Manual of Mental Disorders (APA, 1994)2

Hamilton Depression Rating Scale (HAM-D-17)

HAM-D-17 is one of the most widely used scales for rating the severity of depression in patients and comprises 17 items in the shorter version3

Hoehn & Yahr Scale

The Hoehn & Yahr scale is a commonly used scale for describing how the symptoms of Parkinson's disease (PD) progress. The Hoehn & Yahr scale allocates stages from 0 to 5 to indicate the relative level of disability for the patient. Stage 0 = mild symptoms and stage 5 = most severe disease stage.4 Click here for more information

Stage One
  1. Signs and symptoms on one side only
  2. Symptoms mild
  3. Symptoms inconvenient but not disabling
  4. Usually presents with tremor of one limb
  5. Friends have noticed changes in posture, locomotion and facial expression
Stage Two
  1. Symptoms are bilateral
  2. Minimal disability
  3. Posture and gait affected
Stage Three
  1. Significant slowing of body movements
  2. Early impairment of equilibrium on walking or standing
  3. Generalised dysfunction that is moderately severe
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
Stage Five
  1. Cachectic stage
  2. Invalidism complete
  3. Cannot stand or walk
  4. Requires constant nursing care

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Hospital Anxiety and Depression Scale (HADS)

HADS is a brief self-report measure of anxiety and depression. The scale is composed of 14 items and has two subscales: a depression subscale (HADS-D) and an anxiety subscale (HADS-A) each consisting of seven items5

Non-Motor Symptoms Questionnaire (NMSQuest) for Parkinson’s disease

The NMSQuest is a screening questionnaire for non-motor symptoms in PD comprising 30 items. This instrument has been developed to enable a comprehensive assessment of the range of non-motor symptoms of PD, both for the identification of problems and for the measurement of treatment outcome6

Non-Motor Symptoms Scale (NMSS) for Parkinson’s disease

The NMSS is a 30-item scale for the assessment of non-motor symptoms in PD. It is a clinical tool to assess the progress or potential response to treatment of non-motor symptoms7

Short Parkinson's Evaluation Scale (SPES)

The SPES scale rates motor impairments and disabilities in PD8

Snaith-Hamilton Pleasure Scale (SHAPS-D)

The SHAPS-D scale rates self-reported anhedonia in psychiatric patients9

Unified Parkinson’s Disease Rating Scale (UPDRS)

The UPDRS scale is a rating tool that was developed to provide a comprehensive tool to follow the longitudinal course of PD-related disability and impairment. The UPDRS is the most commonly used instrument to capture multiple aspects of PD. It assesses both motor disability (part II: activities of daily living) and motor impairment (part III: motor section). In addition, part I addresses mental dysfunction and mood and part IV assesses treatment-related motor and non-motor complications. A total score of 199 points is possible. 199 points represent the worst disability and 0 points no disability10

View references

  1. Beck AT et al. The BDI-II Manual. The Psychological Corporation 1996.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th Edition. Washington, DC: American Psychiatric Press 1994.
  3. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56–62.
  4. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17: 427-442.
  5. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361-70.
  6. Chaudhuri KR et al. International multicenter pilot study of the first comprehensive self-completed non-motor symptoms questionnaire for Parkinson's disease: the NMSQuest study. Mov Disord 2006; 21(7): 916–923.
  7. Chaudhuri KR et al. The metric properties of a novel non-motor symptoms scale for Parkinson’s disease: results from an international pilot study. Mov Disord 2007 Oct 15; 22(13): 1901-1.
  8. Rabey JM et al. Evaluation of the Short Parkinson's Evaluation Scale: a new friendly scale for the evaluation of Parkinson's disease in clinical drug trials. Clin Neuropharmacol 1997; 20(4): 322-337.
  9. Snaith RP et al. A scale for the assessment of hedonic tone the Snaith-Hamilton Pleasure Scale. Br J Psychiatry 1995; 167(4): 551.
  10. Fahn S, Marsden CD, Calne DB, Goldstein M, eds. Recent Developments in Parkinson's Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987; 153-163: 293-304.

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