The Parkinson's Disease Rating Scale (PDRS) of Webster et al

Parameter

Finding

Points

bradykinesia of hands

no involvement

0

detectable slowing of the supination-pronation rate; beginning difficulty in handling tools, buttoning clothes, and with handwriting

1

moderate slowing of the supination-pronation rate in one or both sides; moderate impairment of hand function; handwriting is greatly impaired, micrographia present

2

severe slowing of the supination-pronation rate; unable to write or button clothes; marked difficulty in handling utensils

3

rigidity

non-detectable

0

detectable rigidity in neck and shoulders; activation phenomenon is present; one or both arms show mild, negative, resting rigidity

1

moderate rigidity in neck and shoulders; resting rigidity is present if patient is not on medications

2

severe rigidity in neck and shoulders; resting rigidity cannot be reversed by medication

3

posture

normal posture; head flexed forward less than 4 inches

0

beginning poker spine; head flexed forward more than 5 inches

1

beginning arm flexion; head flexed forward up to 6 inches; one or both arms raised but still below waist

2

onset of simian posture; head flexed forward more than 6 inches; one or both hands elevated above the waist; sharp flexion of hands, beginning interphalangeal extension; beginning flexion of knees

3

upper extremity swing

swings both arms well

0

one arm definitely decreased in amount of swing

1

one arm fails to swing

2

both arms fail to swing

3

gait

steps out well with 18-30 inch stride; turns about effortlessly

0

gait shortened to 12-18 inch stride; beginning to strike one heel; turn around time slowing; requires several steps

1

stride moderately shortened to 6-12 inches; both heels beginning to strike floor forcefully

2

onset of shuffling gait; steps less than 3 inches; occasional stuttering-type or blocking gait; walks on toes; turns around very slowly

3

tremor

no detectable tremor found

0

less than 1 inch of peak-to-peak tremor movement observed in limbs or head at rest, or in either hand while walking or during the finger-to-nose testing

1

maximum tremor envelope fails to exceed 4 inches; tremor is severe but not constant and patient retains some control of hands

2

tremor envelope exceeds 4 inches; tremor is constant and severe; patient cannot get free of tremor while awake unless it is a pure cerebellar type; writing and feeding self are impossible

3

facies

normal; full animation; no stare

0

detectable immobility; mouth remains closed; beginning features of anxiety or depression

1

moderate immobility; emotion breaks through at markedly increased threshold; lips parted some of the time; moderate appearance of anxiety or depression; drooling may be present

2

frozen facies; mouth opens >= 0.25 inches; drooling may be severe

3

seborrhea

none

0

increased perspiration, secretions remain thin

1

obvious oiliness present and secretion much thicker

2

marked seborrhea; entire face and head covered by thick secretion

3

speech

clear, loud, resonant, easily understood

0

beginning of hoarseness, with loss of inflection and resonance; good volume and still easily understood

1

moderate hoarseness and weakness; constant monotone, unvaried pitch; beginning of dysarthria, hesitance, stuttering, difficult to understand.

2

marked harshness and weakness; very difficult to hear and to understand

3

self-care

no impairment

0

still provides full self-care, but rate of dressing definitely impeded; able to live alone and may be employable

1

requires help in certain critical areas; very slow in performing most activities but manages by taking much time

2

continuously disabled; unable to dress, feed self or walk alone

3

Scale

Disability

1 – 10

early illness

11 - 20