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.

The charts below give 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.

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.

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.