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.
|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)
|90%||Completely independent. Beginning to be aware of difficulty.|
|80%||Completely independent. Conscious of difficulty and slowness.|
|70%||Not completely independent.|
|30%||Much help needed.|
|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.