Larsen et al developed a rating scale for a patient with Parkinson's disease. This can help monitor the patient over time and the response to therapy. It was to develop to include the severity of delayed problems (confusion, abrupt fluctuation, dyskinesia) associated with chronic L-dopa therapy. The authors are from the University of British Columbia.
Parameters:
(1) daily activities
(1a) best dressing
(1b) worst dressing
(1c) best feeding
(1d) worst feeding
(1e) best hygiene
(1f) worst hygiene
(1g) best turning in bed
(1h) worst turning in bed
(1i) best walking
(1j) worst walking
(2) dyskinesias
(2a) face, neck, trunk
(2b) right upper limb
(2c) left upper limb
(2d) right lower limb
(2e) left lower limb
(2f) duration
(3) wearing off and on-off
(3a) duration of attacks
(3b) frequency of attacks
(4) confusion
|
Grading Daily Activities (Best and Worst) |
Points |
|
normal |
0 |
|
slightly slow but independent |
1 |
|
moderate impairment; may sometimes need assistance or delay activity until mobile |
2 |
|
marked impairment; usually requires assistance; may fall often |
3 |
|
completely unable to perform alone; confined to bed or wheelchair (totally disabled) |
4 |
|
Grading of Dykinesia in Each Section |
Points |
|
absent |
0 |
|
slight amplitude |
1 |
|
moderate amplitude |
2 |
|
marked amplitude |
3 |
|
severe amplitude |
4 |
|
Parameter |
Finding |
Points |
|
duration of dyskinesia |
no dyskinesia |
0 |
|
|
up to 10% of waking hours |
1 |
|
|
11 - 25% of waking hours |
2 |
|
|
26 - 50% of waking hours |
3 |
|
|
> 50% of waking hours |
4 |
|
wearing-off/on-off, duration |
0 to 30 minutes |
1 |
|
|
30 to 60 minutes |
2 |
|
|
1 to 2 hours |
3 |
|
|
more than 2 hours |
4 |
|
wearing-off/on-off, frequency |
0 to 1 per day |
1 |
|
|
2 to 5 per day |
2 |
|
|
6 to 10 per day |
3 |
|
|
more than 10 per day |
4 |
|
confusion |
none |
0 |
|
|
slightly forgetful |
1 |
|
|
forgetful of recent events |
2 |
|
|
forgetful of distant events |
3 |
|
|
disoriented in time or space |
4 |
where:
• Episodes transient akinesias should not be considered as wearing-off or on-off attacks.
• Forgetfulness of recent events is reflected by an inability to recall events for the prior 24 hours.
• Forgetfulness of distant events is a failure to remember birthdays, anniversaries, or other important facts.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum points for daily activity: 0
• maximum points for daily activity: 40
• minimum points for dyskinesia: 0
• maximum points for dyskinesia: 24
• minimum points for wearing-off/on-off: 0
• maximum points for wearing-off/on-off: 16
• minimum points for confusion: 0
• maximum points for confusion: 4
Purpose: To evaluate disability in a patient with Parkinson's disease using the rating scale of Larsen et al.
Specialty: Sports Medicine & Rehabilitation, Neurology
Objective: severity, prognosis, stage, response to therapy, quality of life
ICD-10: G20,
