Update on the Management of Parkinson’s Disease for General Neurologists

Table 2

Instruments for general assessment, health-related quality of life assessment, and complications of Parkinson’s disease.

Assessment tool	Abbrev.	Measures	Grading severity				MCID			Quick tips
Hoehn and Yahr Scale [32]	HYS	General assessment	Mild: HYS 1 and 2; Moderate: HYS 3; Severe: HYS 4 and 5							Besides the original version, a modified version (mHYS) is also available
Unified Parkinson’s Disease Rating Scale [33]	UPDRS	General assessment, 4 subscales: Part I: mentation, behavior and mood; Part II: activities of daily living; Part III: motor examination; Part IV: treatment complications					Part II: 0.7 (early PD) [34], 2 (HYS 1&2) [35], 3 points (HYS 2.5–3) [35]; Part III: 2.4 (early PD) [34], 5 (HYS 1–3) [35], 3.5 (advanced) [36]			In most cases, the total score is calculated as the sum of parts I + II + III
Movement Disorders Society-Sponsored Unified Parkinson’s Disease Rating Scale [37]	MDS-UPDRS	General assessment, 4 subscales: Part I: non-motor experiences of daily living; Part II: motor experiences of daily living; Part III: motor examination; Part IV: motor complications	Score [38]:				Score change:			Solves several ambiguities of UPDRS; subscales should be interpreted separately
				Mild	Moderate	Severe		Improvement	Worsening
			Part I	≤10	11–21	≥22	Part I [39]	−2.64	2.45
			Part II	≤12	13–29	≥30	Part II [39]	−3.05	2.51
			Part III	≤32	33–58	≥59	Part III [40]	−3.25	4.63
Parkinson’s Disease Questionnaire (39 items) [41]	PDQ-39	Disease-specific health-related quality of life; 39 items grouped into 8 domains making up a summary index					Score change [42]: Improvement −4.72 points,; Worsening 4.22 points			One of the most relevant instruments
Parkinson’s Disease Questionnaire (8 items) [43]	PDQ-8	Disease-specific health-related quality of life. 8 questions making up a summary index					Improvement −5.94 [42] (range: −4.6, −10) [36, 44]; Worsening 4.91 points [42]			This is the “short” version of PDQ-39
Nonmotor Symptoms Scale [45]	NMSS	Measures nine domains: Cardiovascular, sleep/fatigue, mood/cognition, perception problems, attention & memory, gastrointestinal- urinary, sexual function, and miscellaneous	Absent or mild: 0–20 points; Moderate: 21–40 points; Severe: 41–70 points; Very severe: ≥ 71 points [46]							There is also a screening instrument (NMSQ); NMSS assesses severity and frequency
Parkinson’s Disease Sleep Scale 2nd version [47]	PDSS-2	Overall sleep quality; 3 subscales on motor problems at night, PD problems at night and disturbed sleep	Absent or minimal: 0–10 points; Mild-moderate: 11–20 points; Severe: ≥20 points [48]				Improvement −3.44 points; Worsening 2.07 points [49]			PDSS-2 is an improved version of the original PDSS
Unified Dyskinesia Rating Scale [50]	UDysRS	Overall assessment of dyskinesia: Part I: historical On-Dyskinesia; Part II: historical Off-Dystonia; Part III: objective Impairment; Part IV: objective disability					Part III: Improvement 2.32 points; Worsening 2.76 points [51]			UDysRS is the most comprehensive dyskinesia scale

MCID, minimal clinically important difference; PD, Parkinson’s disease.