MDS-UPDRS Part IV – Motor Complications
Motor complications, meaning dyskinesias and fluctuations, in Parkinson’s disease. Total 0 to 24.
By Claire White
- 6 items, numbered 4.1 to 4.6, delivered as an interview. The rater reads the instructions out and records the answers.
- Each item is scored 0 for none to 4 for severe. Part IV runs from 0 to 24.
- Covers time spent with dyskinesias, the functional impact of dyskinesias, time spent in the OFF state, the functional impact of fluctuations, the complexity of motor fluctuations, and painful OFF-state dystonia.
- Published by the International Parkinson and Movement Disorder Society.
Psychometrics
Cronbach's alpha for the Part IV total, from Goetz et al. (2008). Higher is better.
What does MDS-UPDRS Part IV measure?
Part IV rates the complications that come with treating Parkinson’s over the long term rather than the disease itself. Its six items, numbered 4.1 to 4.6, cover the time spent with dyskinesias, the functional impact of dyskinesias, the time spent in the OFF state, the functional impact of fluctuations, the complexity of motor fluctuations, and painful OFF-state dystonia. It is delivered as an interview, with the rater reading the instructions out and recording what the person reports.
The scale is licensed, so this page describes what Part IV asks about rather than reproducing its wording. The official form, with the exact instructions and the rating anchors, comes from the International Parkinson and Movement Disorder Society at movementdisorders.org.
What does an MDS-UPDRS Part IV score mean?
Higher means a greater burden from motor complications. A 2015 study of 452 people with Parkinson’s proposed three bands for the Part IV total.
| Part IV total | Severity |
|---|---|
| 0 to 4 | Mild |
| 5 to 12 | Moderate |
| 13 and above | Severe |
The bands are narrow because the scale is short, so a two-point move covers more ground here than on any other part. Read the total with the treatment history beside it. Part IV rates complications that develop on long-term dopaminergic treatment, so a 0 can mean the treatment is well balanced or that there has not yet been enough of it to produce complications. The score is reference information for the care team, not a diagnosis.
How MDS-UPDRS Part IV is administered
- Administered by
- The rater, in interview with the person, using instructions read out from the form
- Time to administer
- About 30 minutes for all four parts. No separate published figure for Part IV.
- 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 MDS-UPDRS Part IV used for?
Related instruments
- MDS-UPDRS Part IIIThe motor examination whose ON and OFF difference Part IV puts a number on
- MDS-UPDRS Part IIHow motor symptoms land on daily tasks, reported by the person
- Parkinson's Disease Questionnaire (PDQ-39)Quality of life across eight areas, including mobility and bodily discomfort
- EQ-5DGeneric health-related quality of life, for comparing across conditions
MDS-UPDRS Part IV questions, answered
How is MDS-UPDRS Part IV scored?
The rater asks about each of the six areas and scores it 0 for none through to 4 for severe. The six scores are added, so Part IV runs from 0 to 24. It is not folded into a total with the other three parts.
What are dyskinesias and OFF time?
Dyskinesias are involuntary movements, and they usually appear when levodopa levels are high. OFF time is the opposite end of the same cycle, the stretch when a dose has worn off and the symptoms it was controlling come back. Part IV asks how much of the day each one takes up and how much they get in the way. It also asks about painful muscle contractions in the OFF state, which are called dystonias.
What does an MDS-UPDRS Part IV score of 0 mean?
It means no motor complications were reported, but read it with the treatment history next to it. Part IV rates complications that develop with long-term dopaminergic treatment, so a 0 in someone newly diagnosed and a 0 in someone on levodopa for fifteen years are different findings. This is the part where the score alone tells you the least.
Who completes MDS-UPDRS Part IV?
The rater does, in conversation with the person. The form carries instructions for the rater and instructions to be read out, so the answers come from the person but the scoring stays with the clinician. Unlike Part II it is not a questionnaire to fill in alone.
How long does MDS-UPDRS Part IV take?
The Movement Disorder Society and the reference databases publish a time for the full four-part scale, about 30 minutes, rather than a figure for Part IV on its own. It is six questions in interview.
Where does the official MDS-UPDRS Part IV form come from?
From the International Parkinson and Movement Disorder Society, which holds the copyright and publishes the form at movementdisorders.org. Anyone administering it themselves requests permission through the form on that site. This page describes what Part IV asks about rather than reproducing the licensed form.
Evidence, psychometrics and provenance
Part IV is one of the four parts of the MDS-UPDRS, published in 2008 by Goetz and colleagues for the International Parkinson and Movement Disorder Society. It is the shortest part and the one with the narrowest population, because it only applies once treatment has been running long enough for complications to appear.
- 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 Part IV (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.Bay A, Hart A, Caudle WM, Corcos DM, Hackney M. The association between Parkinson's disease symptom side-of-onset and performance on the MDS-UPDRS scale Part IV: motor complications. J Neurol Sci. 2018;396:262-265. (Source for the six Part IV items and the interview format.)
- 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.