What are the Parkinson's disease scales?

*The reference scale is only for medical professionals to read.
The reference scale is an essential tool for assessing the degree of disease and for objective diagnosis and treatment.

Every year, April 11th is World Parkinson's Day, and Parkinson's disease (PD) is the second largest neurodegenerative disease.

There are currently more than 2.
7 million PD patients in my country.
As the aging society intensifies, PD patients are increasing at a rate of 100,000 per year.
In addition to the classic four main signs of PD (bradykinesia, resting tremor, muscle rigidity and postural balance) Disorder) is the main manifestation.
PD also has many non-motor symptoms: such as cognitive impairment, hyposmia, and constipation.

In addition, PD patients may also experience dyskinesias, end-of-dose (WO), etc.
after receiving effective treatment.
How should these be determined? It is not enough to rely solely on the subjective judgment of the doctor, and it is also unscientific.
We also need some objective scale assessments to help clinicians make better judgments and diagnosis and treatment.
What scales are there? Next, let us learn it! 1.
Unified parkinson's disease rating scale (UPDRS) 1.
Scale introduction The Parkinson’s Disease Unified Rating Scale (UPDRS) has six subscales: the first subscale—used to judge the degree of mental activity, behavior and affective disorder of PD patients; the second subscale—used to judge PD The patient’s ability of daily living; the third subscale—used to judge the motor function of the PD patient; the fourth subscale—used to judge the treatment complications of the PD patient within 1 week of treatment; the fifth subscale—used to Judging the degree of disease development in the course of PD patients; the sixth subscale-used to judge the difference between the degree of PD patients in the best state of active function ("on" period) and the worst state of active function ("off" period).

Through the evaluation of these scales, after careful analysis, a very objective judgment can be made on PD patients' exercise, ability of daily living, course of disease development, status after treatment, side effects and complications of treatment.

2.
Scale content 3.
Scale explanation: The score value of each item in the table (items 1-17) uses five levels of 0, 1, 2, 3, and 4.

The higher the score, the more severe the symptoms of PD patients.

(Items 18 to 31) The scoring value of each item is 0, 0.
5, 1.
0, 1.
5, 2.
0, 2.
5, 3.
0, 3.
5, 4.
0; there is a difference of 0.
5 among the 4 levels of 5 levels.

The higher the examination score of PD patients' physical signs, the more serious the disease.

However, due to the many items of the scale, it takes a lot of time to make a score, so it is inconvenient for clinical application.

For this reason, some people often take several subscales to judge the disease of PD patients.

The most commonly used subscale is the third subscale, which is used to determine the motor function of the patient's PD.

Two Parkinson’s Disease Hoehn and Yahr Grading Scale 1.
Scale introduction Hoehn-Yahr classification (HY classification for short) is a classification table used to record Parkinson's disease.

This table was published in the American Neurology journal in 1967 by Melvin Yahr and Margaret Hoehn.

Although simple, it is widely used to evaluate the clinical condition of PD.
In recent years, a modified HY classification has been produced, which is accepted by most physicians.

2.
The content of the scale 3.
Scale explanation The scale is also used as the fifth subscale of UPDRS (UPDRS subscale V) HOEHN&YAHR score to grade the severity of symptoms.

The improved HY classification is simple and clear, and has strong operability.
The assessment content includes daily life and sports functions, and effectively shows the progress of the disease.

Three Scoring Criteria of Webster Symptoms 1.
Scale introduction The improved Webster scoring method for PD is also commonly used in China.

The modified Webster symptom scoring method we currently use is as follows.

2.
Scale content: There are ten major symptoms, and each symptom is divided into 4 levels, namely normal (0 points), mildly abnormal (1 point), moderately abnormal (2 points) and severely abnormal (3 points).

The ten symptoms classification standards are as follows: 3.
The scale explanation finally adds up the scores of the ten major symptoms.
Those with a score below 10 are mild patients, those with a score of 10-20 are moderately ill, and those with a score of 21-30 are severely ill.

4.
Schwab and England Daily Activity Scale 1.
Introduction to the scale is a scale developed by Schwab RS and England AC in 1969 to describe the ability of daily living of PD patients.

The evaluation of PD patients is mainly from the aspects of dependence, daily ability, etc.
, and is divided into ten levels.

2.
Scale content 3.
Scale explanation According to the description of the above symptoms, the daily activity ability of PD patients is graded.
There are ten levels.
The smaller the activity (0-100%), the more severe the patient's symptoms.

The modified Schwab England scoring scale is also used as the sixth subscale of UPDRS (UPDRS subscale Ⅵ) for PD patients in the best state of active function ("on" period) and in the worst state of active function ("off" period) .

It can be assessed by medical staff by collecting medical history or by patients.

Five dyskinesia rating scale 1.
Introduction to the dyskinesia rating scale, which was reported by Goetz et al.
in 1994 based on the performance of the videotaped exercise task.
It was recorded through the video recording of the task performed by the patient and assigned a full severity score (0～4).
Points) to identify the type and severity of dyskinesia.

2.
The content of the scale 3.
The explanation of the scale The classification for comprehensively assessing the severity of dyskinesia (based on daily activities, divided into 0 to 4 levels; it can be used to distinguish the two main symptoms of dyskinesia in PD patients: chorea-like movements and dystonia ; It can clarify the single most serious form of disability dyskinesia.

Its advantage is that it can clearly define the performance characteristics of physical performance and motor tasks, reduce subjectivity, convenient application, and can be used as an auxiliary method of UPDRS.

Six WO Evaluation Scale 1.
Introduction to the Scale The End-of-agent Phenomenon Questionnaire (WOQ-9) is widely used in the screening of WO.
WOQ-9 is simple and easy to implement, with a sensitivity of 96.
2% and a specificity of 40.
9%.
The screening tool has strong practicability and can be promoted and used in clinical practice.

2.
The content of the scale 3.
The scale explains that if the patient has the above symptoms during the treatment period, mark "√" in the corresponding box in the symptom column.
If the symptoms of medication are relieved, then mark "√" in the corresponding box in the relief column.

For the same symptom, there is a "√" in both the symptom column and the relief column, indicating that the "WO" may have appeared.

Seven summary In addition to the above-mentioned commonly used scales, the related scales used for PD are summarized as follows: 1.
Overall scale: PD Unified Score Scale (UPDRS) 2.
Motor symptoms, motor symptoms complications and severity of illness assessment Scale: Hoehn-Yahr staging (HY staging), modified Webster symptom score, Schwab and England Daily Daily Life Scale, etc.
3.
Non-motor symptom scale: non-motor symptom questionnaire, simple mental performance status scale (MMSE), Montreal Cognitive Assessment (MoCA) Scale, Depression Self-Rating Scale (SDS), Hamilton Anxiety and Depression Scale, Pittsburgh Sleep Quality Index (PSQI) Scale, Fatigue Severity Scale (FSS), Constipation Scale, Severe Restless Legs Degree rating scale, neuropsychiatric symptom questionnaire (NPI), etc.
4.
Quality of life scale: PD quality of life questionnaire (PDQL-39), ability of daily living (ADL) scale, etc.
5.
Treatment evaluation scale: Dyskinesia rating The above scales, such as the WO rating scale, etc.
, are all sorted out by individuals.
Doctors are welcome to correct and supplement them~ April 11, 2021 is the 25th World Parkinson’s Day, in order to enable all doctors to better understand the diagnosis and treatment of PD Methods, to understand the latest progress of the disease, we hereby invite 5 experts from the Department of Neurology, Xuanwu Hospital, Capital Medical University, to give lectures together.

The content of this series of courses is concise and clear, vivid and specific, and should not be missed.

Reference: [1]Webster DD.
Critical analysis of the disability in Parkinson's disease.
Modern Treatment.
1968(March);257-282.
[2]Schwab RS, England AC Jr.
Projection techniques for evaluating surgery in Parkinson's Disease.
pages 152-157 (Table 1, page 153).
IN: Third Symposium on Parkinson's Disease, Royal College of Surgeons in Edinburgh, May 20-22, 1968.
E.
& S.
Livingstone Ltd.
1969 [3] Hoehn MM, Yahr MD.
Parkinsonism: onset, progression, and mortality.
Neurology 1967; 17: 427-42.
[4] Fahn S, Elton RL, Members of the UPDRS Development Committee.
In: 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: 153-64.
[5] Chen Xiaochun, Pan Xiaodong editor.
Handbook of Neurology Physical Examination and Common Scales.
Beijing: Chemical Industry Press.
2013.
05 [6] Robert M.
Herndon editor in chief; Jia Jianping, Chen Hai, Yan Xin and other translations.
Neurological Disease Grading Scale (Second Edition).
Beijing: Chemical Industry Press.
2010.
01