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Unified Parkinson's Disease Rating Scale (UPDRS 3.0)

I. Mental, Behavior, and Mood
1. Intellectual Impairment
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1. Intellectual Impairment
None
Mild intellectual impairment, persistent forgetfulness, can partially recall past events, no other difficulties
Moderate memory impairment, disorientation, moderate difficulty solving complex problems
Severe memory impairment with frequent disorientation in time and place, severe difficulty solving problems
Severe memory impairment, only retains person orientation, unable to make judgments or solve problems, needs help with daily life
2. Thought Disorder (due to dementia or drug intoxication)
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2. Thought Disorder (due to dementia or drug intoxication)
None
Vivid dreams
"Benign" hallucinations, good insight
Occasional or frequent hallucinations or delusions, no insight, may affect daily activities
Persistent hallucinations, delusions, or colorful psychosis, unable to care for self
3. Depression
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3. Depression
None
More pessimistic and guilty than usual, lasts less than 1 week
Persistent depression (1 week or more)
Persistent depression with autonomic symptoms (insomnia, decreased appetite, weight loss, decreased interest)
Persistent depression with autonomic symptoms and suicidal thoughts or intentions
4. Motivation or Initiative
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4. Motivation or Initiation
Normal
Less decisive than usual, more passive
No interest or motivation for selective (non-routine) activities
No interest or motivation for daily (routine) activities
Withdrawn, completely unmotivated
II. Activities of Daily Living
5. Speech (Reception)
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5. Speech (Reception)
Normal
Slightly affected, no difficulty understanding
Moderately affected, sometimes requires repetition to understand
Severely affected, often requires repetition to understand
Often unable to understand
6. Salivation
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6. Salivation
Normal
Slight but definite increase in saliva in the mouth, may have nighttime drooling
Moderate increase in saliva, may have slight drooling
Marked increase in saliva with drooling
Marked drooling, requires constant use of tissues or handkerchief
7. Swallowing
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7. Swallowing
Normal
Rarely chokes
Occasionally chokes
Requires soft food
Requires feeding tube or gastrostomy
8. Writing
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8. Writing
Normal
Slightly slow or small handwriting
Moderately slow or small handwriting, all writing is legible
Severely affected, not all writing is legible
Most writing is illegible
9. Cutting Food and Using Utensils
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9. Cutting Food and Using Utensils
Normal
Slightly slow and clumsy, but does not need help
Slow and clumsy, but can cut most foods, needs some help
Needs help cutting food, but can feed self slowly
Needs to be fed
10. Dressing
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10. Dressing
Normal
Slightly slow, no help needed
Occasionally needs help with buttons and putting arms in sleeves
Needs considerable help but can do some things independently
Completely needs help
11. Personal Hygiene
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11. Personal Hygiene
Normal
Slightly slow, no help needed
Needs help with showering or bathing, or very slow with personal hygiene
Needs help with washing face, brushing teeth, combing hair, and bathing
Needs catheterization or other mechanical assistance
12. Turning in Bed and Adjusting Bedclothes
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12. Turning in Bed and Adjusting Bedclothes
Normal
Slightly slow and clumsy, no help needed
Can turn and adjust bedclothes independently but with difficulty
Can initiate but not complete turning or adjusting bedclothes
Completely needs help
13. Falling (unrelated to freezing)
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13. Falling (unrelated to freezing)
None
Occasional
Sometimes, less than once a day
Average of once a day
More than once a day
14. Freezing While Walking
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14. Freezing While Walking
None
Rare, may have start hesitation
Occasional freezing
Frequent, occasional falls due to freezing
Frequent falls due to freezing
15. Walking
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15. Walking
Normal
Slight difficulty, may have reduced arm swing or tendency to drag feet
Moderate difficulty, needs little or no help
Severe difficulty, needs help
Cannot walk even with help
16. Tremor
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16. Tremor
None
Slight, infrequent
Moderate, bothersome
Severe, many activities affected
Marked, most activities affected
17. Sensory Complaints Related to Parkinson's Disease
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17. Sensory Complaints Related to Parkinson's Disease
None
Occasional numbness, tingling, or mild pain
Frequent numbness, tingling, or mild pain, not distressing
Frequent distressing pain
Severe distressing pain
Ⅲ. Motor Examination
18. Speech (Expression)
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18. Speech (Expression)
Normal
Mildly reduced expression, comprehension, and/or volume
Monotone, slurred but understandable, moderately impaired
Monotone, slurred but understandable, severely impaired
Unintelligible
19. Facial Expression
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19. Facial Expression
Normal
Slightly stiff, possibly normal "poker face"
Mild but definite facial expression deficit
Moderately stiff, sometimes mouth open
Mask-like face, almost no expression, mouth open 1/4 inch (0.6 cm) or more
20. Rest Tremor:
20a. Face, Lips, Chin
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20a. Face, Lips, Chin
None
Mildly reduced expression, comprehension, and/or volume
Monotone, slurred but understandable, moderately impaired
Monotone, slurred but understandable, severely impaired
Unintelligible
20b. Right Upper Limb
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20b. Right Upper Limb
None
Mild, occasional
Small amplitude, continuous or moderate amplitude, intermittent
Moderate amplitude, most of the time
Large amplitude, most of the time
20c. Left Upper Limb
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20c. Left Upper Limb
None
Mild, occasional
Small amplitude, continuous or moderate amplitude, intermittent
Moderate amplitude, most of the time
Large amplitude, most of the time
20d. Right Lower Limb
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20d. Right Lower Limb
None
Mild, occasional
Small amplitude, continuous or moderate amplitude, intermittent
Moderate amplitude, most of the time
Large amplitude, most of the time
20e. Left Lower Limb
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20e. Left Lower Limb
None
Mild, occasional
Small amplitude, continuous or moderate amplitude, intermittent
Moderate amplitude, most of the time
Large amplitude, most of the time
21. Hand Action or Postural Tremor:
21a. Right Upper Limb
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21a. Right Upper Limb
None
Mild, occurs during activity
Moderate amplitude, occurs during activity
Moderate amplitude, occurs when holding objects or during activity
Large amplitude, affects eating
21b. Left Upper Limb
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21b. Left Upper Limb
None
Mild, occurs during activity
Moderate amplitude, occurs during activity
Moderate amplitude, occurs when holding objects or during activity
Large amplitude, affects eating
22. Rigidity:
22a. Neck
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22a. Neck
None
Mild, or only detectable with mirror movements and reinforcement tests
Mild to moderate
Marked, but range of motion not limited
Severe, range of motion limited
22b. Right Upper Limb
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22b. Right Upper Limb
None
Mild, or only detectable with mirror movements and reinforcement tests
Mild to moderate
Marked, but range of motion not limited
Severe, range of motion limited
22c. Left Upper Limb
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22c. Left Upper Limb
None
Mild, or only detectable with mirror movements and reinforcement tests
Mild to moderate
Marked, but range of motion not limited
Severe, range of motion limited
22d. Right Lower Limb
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22d. Right Lower Limb
None
Mild, or only detectable with mirror movements and reinforcement tests
Mild to moderate
Marked, but range of motion not limited
Severe, range of motion limited
22e. Left Lower Limb
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22e. Left Lower Limb
None
Mild, or only detectable with mirror movements and reinforcement tests
Mild to moderate
Marked, but range of motion not limited
Severe, range of motion limited
23. Finger Tapping Test (thumb and index finger perform continuous opposition movements as widely and quickly as possible):
23a. Right Hand
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23a. Right Hand
Normal (≥15 times/5 seconds)
Mild slowing and/or reduced amplitude (11-14 times/5 seconds)
Moderate impairment, definite early fatigue, occasional pauses during movement (7-10 times/5 seconds)
Severe impairment, difficulty initiating movement or pauses during movement (3-6 times/5 seconds)
Almost unable to perform the action (0-2 times/5 seconds)
23b. Left Hand
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23b. Left Hand
Normal (≥15 times/5 seconds)
Mild slowing and/or reduced amplitude (11-14 times/5 seconds)
Moderate impairment, definite early fatigue, occasional pauses during movement (7-10 times/5 seconds)
Severe impairment, difficulty initiating movement or pauses during movement (3-6 times/5 seconds)
Almost unable to perform the action (0-2 times/5 seconds)
24. Hand Movements (perform rapid continuous opening and closing of the hand as widely as possible):
24a. Right Hand
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24a. Right Hand
Normal
Mild slowing or reduced amplitude
Moderate impairment, definite early fatigue, occasional pauses during movement
Severe impairment, frequent hesitation when initiating movement or pauses during movement
Almost unable to perform the action
24b. Left Hand
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24b. Left Hand
Normal
Mild slowing or reduced amplitude
Moderate impairment, definite early fatigue, occasional pauses during movement
Severe impairment, frequent hesitation when initiating movement or pauses during movement
Almost unable to perform the action
25. Alternating Movements (perform maximum amplitude pronation and supination movements with both hands vertically or horizontally):
25a. Right Hand
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25a. Right Hand
Normal
Mild slowing or reduced amplitude
Moderate impairment, definite early fatigue, occasional pauses during movement
Severe impairment, frequent hesitation when initiating movement or pauses during movement
Almost unable to perform the action
25b. Left Hand
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25b. Left Hand
Normal
Mild slowing or reduced amplitude
Moderate impairment, definite early fatigue, occasional pauses during movement
Severe impairment, frequent hesitation when initiating movement or pauses during movement
Almost unable to perform the action
26. Leg Agility (rapid continuous heel tapping with the leg fully raised, amplitude about 2 cm):
26a. Right Lower Limb
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26a. Right Lower Limb
Normal
Mild slowing or reduced amplitude
Moderate impairment, definite early fatigue, occasional pauses during movement
Severe impairment, frequent hesitation when initiating movement or pauses during movement
Almost unable to perform the action
26b. Left Lower Limb
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26b. Left Lower Limb
Normal
Mild slowing or reduced amplitude
Moderate impairment, definite early fatigue, occasional pauses during movement
Severe impairment, frequent hesitation when initiating movement or pauses during movement
Almost unable to perform the action
27. Standing Up (patient stands up from a straight-backed wooden or metal chair with arms crossed over chest)
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27. Standing Up (patient stands up from a straight-backed wooden or metal chair with arms crossed over chest)
Normal
Slow, or may require more than one attempt
Needs to use armrests to stand up
Tendency to fall backward, must try several times to stand up, but does not need assistance
Cannot stand up without assistance
28. Posture
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28. Posture
Normal upright
Not very upright, mild forward flexion, may be normal for elderly
Moderate forward flexion, definitely abnormal, may have mild lateral flexion
Severe forward flexion with kyphosis, may have moderate lateral flexion
Marked flexion, extremely abnormal posture
29. Gait
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29. Gait
Normal
Slow walking, may have shuffling, small steps, but no festination or propulsion
Difficulty walking, but does not need assistance, may have some degree of festination, small steps, or propulsion
Severely abnormal gait, needs assistance to walk
Cannot walk even with assistance
30. Postural Stability (response to a sudden backward pull on the shoulders, patient should stand with eyes open, feet slightly apart, and ready)
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30. Postural Stability (response to a sudden backward pull on the shoulders, patient should stand with eyes open, feet slightly apart, and ready)
Normal
Retropulsion, can recover unaided
No postural response, would fall if not caught
Very unstable, spontaneous loss of balance
Cannot stand without assistance
31. Bradykinesia (slow combing, reduced arm swing, reduced amplitude, overall reduced activity)
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31. Bradykinesia (slow combing, reduced arm swing, reduced amplitude, overall reduced activity)
None
Slightly slow, seems deliberate, may be normal in some people, amplitude may be reduced
Mild slowness and reduction in movement, definitely abnormal, or reduced amplitude
Moderate slowness, lack of movement, or reduced amplitude
Marked slowness, lack of movement, or reduced amplitude
IV. Complications of Therapy:
A. Dyskinesia
32. Duration: (proportion of the day dyskinesia is present during waking hours - historical information)
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32. Duration: (proportion of the day dyskinesia is present during waking hours - historical information)
None
1% - 25%
26% - 50%
51% - 75%
76% - 100%
33. Disability: (degree of disability due to dyskinesia - historical information, may be modified by examination)
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33. Disability: (degree of disability due to dyskinesia - historical information, may be modified by examination)
No disability
Mild disability
Moderate disability
Severe disability
Complete disability
34. Degree of Pain Caused by Painful Dyskinesia
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34. Degree of Pain Caused by Painful Dyskinesia
No painful dyskinesia
Mild
Moderate
Severe
Extreme
35. Morning Dystonia
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35. Morning Dystonia
None
Present
B. Clinical Fluctuations
36. Can "Off" Periods Be Predicted Based on Medication Timing
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36. Can "Off" Periods Be Predicted Based on Medication Timing
No
Yes
37. Can "Off" Periods Not Be Predicted Based on Medication Timing
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37. Can "Off" Periods Not Be Predicted Based on Medication Timing
No
Yes
38. Do "Off" Periods Occur Suddenly (e.g., within seconds)
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38. Do "Off" Periods Occur Suddenly (e.g., within seconds)
No
Yes
39. Proportion of "Off" Time During Waking Hours
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39. Proportion of "Off" Time During Waking Hours
None
1% - 25%
26% - 50%
51% - 75%
76% - 100%
C. Other Complications
40. Does the Patient Have Loss of Appetite, Nausea, or Vomiting
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40. Does the Patient Have Loss of Appetite, Nausea, or Vomiting
No
Yes
41. Does the Patient Have Sleep Disorders (e.g., Insomnia or Hypersomnia)
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41. Does the Patient Have Sleep Disorders (e.g., Insomnia or Hypersomnia)
No
Yes
42. Does the Patient Have Orthostatic Hypotension or Dizziness
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42. Does the Patient Have Orthostatic Hypotension or Dizziness
No
Yes
Score: