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Hoehn and Yahr Scale
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Core: Parkinson's Disease (PD)
Short Description of Instrument
The Hoehn and Yahr (HY) scale is the most widely used and universally accepted staging system for overall functional disability of PD, applied in clinical care and research. It is a categorical staging system that mixes two concepts of disability and impairment: unilaterality vs. bilaterality and absence vs. presence of balance impairment. It is easily applied, is time honored, having been used internationally since the 1960's, allowing for broad classification of PD patients.
Comments/Special Instructions
An important clinical hallmark of disease functional progression is the transition to Stage 3 HY. Once Stage 3 is reached, progression to more disability is difficult to halt, and efforts to maintain patients at HY Stage 2, even if side effects occur such as dyskinesia, is a strategy to protect independence.
Scoring and Psychometric Properties
Scoring: In the original scale, five options exist with descriptive anchors, summarized as 1-unilateral; 2=bilateral with normal balance; 3=bilateral with modest balance problems, but independent; 4=bilateral with major balance problems, still able to walk and stand but with a proclivity to falls; 5=chair or bed bound. A modified version introducing intermediate stages (1.5 and 2.5) was developed, but not soundly tested clinimetrically and its use discouraged in the official evaluation by the Movement Disorder Society (MDS).
Psychometric Properties: The original scale has demonstrated reliability and high convergent validity with other measures of PD. Partly because of the large categories implicit to the HY scale and partly because balance impairment is not particularly helped by dopaminergic drugs, the HY Scale does not fulfill high Responsivity dimensions in clinimetric analyses. In the MDS Scale Evaluation Program, the HY Scale was listed as Recommended. There is no Minimal Clinically Relevant Difference (MCRD) or Minimal Clinically Relevant Incremental Difference (MCRID) established for this scale, primarily because the minimal assumptions needed for such testing are not met.
Key Reference:
Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967 May;17(5):427-42.
Additional References:
Alves G, Wentzel-Larsen T, Aarsland D, Larsen JP. Progression of motor impairment and disability in Parkinson disease: a population-based study. Neurology. 2005 Nov 8;65(9):1436-41.
Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, Giladi N, Holloway RG, Moore CG, Wenning GK, Yahr MD, Seidl L; Movement Disorder Society Task Force on Rating Scales for Parkinson's Disease. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord. 2004 Sep;19(9):1020-8.
Goetz CG, Stebbins GT, Blasucci LM. Differential progression of motor impairment in levodopa-treated Parkinson's disease. Mov Disord. 2000 May;15(3):479-84.
Hely MA, Morris JG, Traficante R, Reid WG, O'Sullivan DJ, Williamson PM. The sydney multicentre study of Parkinson's disease: progression and mortality at 10 years. J Neurol Neurosurg Psychiatry. 1999 Sep;67(3):300-7.
Marttila RJ, Rinne UK. Disability and progression in Parkinson's disease. Acta Neurol Scand. 1977 Aug;56(2):159-69.
Sato K, Hatano T, Yamashiro K, Kagohashi M, Nishioka K, Izawa N, Mochizuki H, Hattori N, Mori H, Mizuno Y; Juntendo Parkinson Study Group. Prognosis of Parkinson's disease: time to stage III, IV, V, and to motor fluctuations. Mov Disord. 2006 Sep;21(9):1384-95.
Document last updated August 2022