MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)
The standard rating scale for Parkinson’s disease, covering motor and non-motor domains across four parts.
By Claire White
- Four parts. Parts I and II are reported by the person or a carer with the investigator's review, Part III is a clinician's examination, and Part IV is completed by the clinician.
- Part I runs 0 to 52, Part II 0 to 52, Part III 0 to 132, and Part IV 0 to 24. Each part is summed on its own, not into one total.
- About 30 minutes for the full scale, with pen and paper.
- Published by the International Parkinson and Movement Disorder Society.
Psychometrics
Cronbach's alpha for each part, from Goetz et al. (2008). Higher is better.
The four parts of the MDS-UPDRS
Each part can be taken on its own. Open a part to see what it measures and to start it.
MDS-UPDRS Part I – Non-Motor Experiences of Daily Living
13 items on mood, sleep, thinking, and other non-motor effects. Score 0 to 52.
MDS-UPDRS Part II – Motor Experiences of Daily Living
13 items on the daily impact of motor symptoms, reported by the person. Score 0 to 52.
MDS-UPDRS Part III – Motor Examination
The clinician's motor examination. 18 items, 33 scores. Score 0 to 132.
MDS-UPDRS Part IV – Motor Complications
6 items on dyskinesias and motor fluctuations. Score 0 to 24.
What does the MDS-UPDRS measure?
The MDS-UPDRS covers the whole of Parkinson’s disease, not only its movement signs. Part I asks about non-motor experiences of daily living, including thinking, hallucinations, mood, apathy, sleep, pain, urinary problems, constipation, light-headedness, and fatigue. Part II asks how motor symptoms land on everyday tasks such as speech, eating, dressing, handwriting, turning in bed, and walking. Part III is the clinician’s examination of motor signs, covering speech, facial expression, rigidity, finger and foot movements, rising from a chair, gait, freezing, postural stability, posture, and tremor. Part IV rates the complications that come with long-term treatment, meaning dyskinesias and motor fluctuations.
The scale has 50 items in total. Part III produces 33 separate scores from its 18 examination items, because most of them are rated on each side of the body, which is why the scale is sometimes described as having 65 scored elements instead.
What does an MDS-UPDRS score mean?
Every item is scored from 0 to 4, where 0 is normal and 4 is severe. Each part is summed on its own rather than into a single total. Part I has 13 items and runs from 0 to 52. Part II has 13 items and runs from 0 to 52. Part III yields 33 scores and runs from 0 to 132. Part IV has 6 items and runs from 0 to 24. The scale’s own validation supports reading the parts separately, so there is no accepted grand total.
A 2015 study of 452 people with Parkinson’s proposed a mild, moderate, and severe band for each part.
| Part | Mild | Moderate | Severe |
|---|---|---|---|
| Part I | 0 to 10 | 11 to 21 | 22 and above |
| Part II | 0 to 12 | 13 to 29 | 30 and above |
| Part III | 0 to 32 | 33 to 58 | 59 and above |
| Part IV | 0 to 4 | 5 to 12 | 13 and above |
The bands are reference information for the care team, tracked over time. Two limits are worth stating plainly. Part III depends on medication state, so an ON score and an OFF score are not comparable and the state should be recorded with the number. And Part IV only applies to people on long-term dopaminergic treatment, so a 0 there can mean no complications or no treatment yet.
How the MDS-UPDRS is administered
- Administered by
- Parts I and II by the person or a carer, reviewed by the investigator. Parts III and IV by the rater.
- Time to administer
- About 30 minutes for the full four-part scale
- Equipment
- Pen and paper
- Cost
- Free to take here.
- Published by
- International Parkinson and Movement Disorder Society
- Permission
- Required for each use, through the permission request form at movementdisorders.org
- Training required
- The Movement Disorder Society runs a certificate program for raters
- Age range
- Adults
- Available languages
- Official translations in more than 25 languages
Which conditions is the MDS-UPDRS used for?
Related instruments
- Parkinson's Disease Questionnaire (PDQ-39)Quality of life in Parkinson's, reported by the person rather than rated by a clinician
- Montreal Cognitive Assessment (MoCA)Cognition in more depth than Part I's single item
- Essential Tremor Rating Assessment Scale (TETRAS)Tremor severity when the diagnosis is essential tremor rather than Parkinson's
- EQ-5DGeneric health-related quality of life, for comparing across conditions
MDS-UPDRS questions, answered
What does an MDS-UPDRS score mean?
Each part is read on its own, and higher means more severe. A 2015 study of 452 people with Parkinson's proposed a mild, moderate, and severe band for each part. On Part III, the motor examination and the part most often quoted alone, up to 32 is mild, 33 to 58 is moderate, and 59 or more is severe. The bands for the other three parts are in the table above. They are reference information. Your neurologist reads the scores in context, alongside the examination and how long you have had the diagnosis.
What is the difference between the UPDRS and the MDS-UPDRS?
The original UPDRS was published in 1987. The International Parkinson and Movement Disorder Society revised it in 2008, adding non-motor items, rewriting the instructions, and standardizing every item to a 0 to 4 rating. The revision is the MDS-UPDRS, and it is the version in standard use.
Is there one total MDS-UPDRS score?
The four parts are summed separately, not into one number. When a study quotes a single score, it is usually Part III, the motor examination.
Where can I get the official MDS-UPDRS PDF?
From the International Parkinson and Movement Disorder Society, which holds the copyright and publishes the form at movementdisorders.org. There is one route and it is the society's own. Anyone administering the scale themselves requests permission through the form on that site. The society also publishes official translations in more than 25 languages and runs a certificate program that trains raters. The pages here describe what each part covers rather than reproducing the licensed form.
Who completes each part?
Parts I and II come from the person or a carer, reviewed by the investigator. Part III is a clinician's examination. Part IV is completed by the clinician with the person.
How long does the MDS-UPDRS take?
About 30 minutes for all four parts, using pen and paper. Parts I and II can be filled in before the visit, which leaves the clinician's time for the Part III examination and the Part IV history.
Evidence, psychometrics and provenance
Fahn, Elton and the UPDRS Development Committee published the original scale in 1987. The International Parkinson and Movement Disorder Society commissioned a critique of it and published the revision in 2008, with Goetz and colleagues as its authors. The revision correlates with the original at rho 0.96, so the two track each other closely. An independent group later validated the Spanish version in 435 people across five countries and reproduced the original clinimetric results.
- Agreement with the original UPDRS
- rho 0.96 (Goetz et al., 2008)
- Test-retest reliability
- ICC above 0.85 for each part's total (Martinez-Martin et al., 2013)
- Factor structure
- Comparative fit index above 0.90 for every part (Goetz et al., 2008)
References
- 1.Goetz CG, Tilley BC, Shaftman SR, et al. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008;23(15):2129-2170.
- 2.Martinez-Martin P, Rodriguez-Blazquez C, Alvarez-Sanchez M, et al. Expanded and independent validation of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). J Neurol. 2013;260(1):228-236.
- 3.Martinez-Martin P, Rodriguez-Blazquez C, Alvarez M, et al. Parkinson's disease severity levels and MDS-Unified Parkinson's Disease Rating Scale. Parkinsonism Relat Disord. 2015;21(1):50-54.
- 4.Fahn S, Elton RL; UPDRS Development Committee. The Unified Parkinson's Disease Rating Scale. In: Recent Developments in Parkinson's Disease, Vol 2. Florham Park, NJ: Macmillan Health Care Information; 1987:153-163.
- 5.International Parkinson and Movement Disorder Society. MDS-UPDRS: rating scale, permission request form, translations, and rater certificate program. movementdisorders.org.
- 6.Shirley Ryan AbilityLab. Rehabilitation Measures Database: MDS-UPDRS. Administration, cost, and per-part internal consistency, citing Goetz et al. (2008).
This assessment uses a validated instrument and is reference information, not a diagnosis. The MDS-UPDRS is copyright the International Parkinson and Movement Disorder Society. This page describes the scale and does not reproduce it. Permission for each use is requested at movementdisorders.org.