April 14, 2021

Parkinson’s Disease Stages

Various systems to categorize Parkinson’s disease stages have been used by clinicians and researchers on a worldwide basis since 1987.

The 3 systems in most widespread use include:

• Hoelm and Yahr.

• Schwab and England.

• Unified Parkinson’s Disease Rating Scale.


Parkinson's Disease Stages

Parkinson's Disease Stages

The charts below gives a comparison of the 3 systems:

Hoelm and Yahr

Note: Modified system includes the proposed points 1.5 and 2.5 as indicated below.

0 No disease.
1 Disease one side only.
1.5 Disease one side and axial involvement.
2 Both sides. No balance problems.
2.5 Disease both sides mild. Recovery on pull test.
3 Balance problems. Physically independent. Disease both sides mild to moderate.
4 Walk or stand unaided. Severe disability.
5 Requires assistance otherwise bedridden or wheelchair bound.


Schwab and England Activities of Daily Living Scale (ADL)

 100% Completely independent.
 90% Completely independent. Beginning to be aware of difficulty.
 80% Completely independent. Conscious of difficulty and slowness.
 70% Not completely independent.
 60% Some dependency.
 50% More dependent.
 40% Very dependent.
 30% Much help needed.
 20% Severe invalid.
 10% Complete invalid.
 0% Bedridden and vegetative functions e.g. bladder functions are not functioning.


Unified Parkinson’s Disease Rating Scale (UPDRS)

1 Evaluation of mentation, behavior and mood including intellectual impairment, thought disorder, depression and motivation/initiative.
2 Activities of daily living (ADL). Evaluation of various factors such as speech, swallowing, handwriting, turning in bed etc.
3 Clinician scored motor evaluation such as hand movements, tremors, rigidity, arising from chair and gait.
4 Complications of therapy including dyskinesias, clinical fluctuations and other complications.
5 Hoehm and Yahr modified system.
6 Schwab and England ADL scale.


The next article in this series will address the issue of Parkinson’s disease prognosis.