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Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS)
Please visit this website for more information about the instrument: Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS)
The instrument is freely available for Individual/Personal use. Permission is required to use this instrument for any other purpose than individual use. This includes clinical trials and training programs. For all other uses please consult the permission form located on the first page of the Scale.
Core: Parkinson's Disease (PD) [select either MDS-UPDRS (for studies focused on all severities and especially on mild/moderate participants) or UPDRS (for studies focused preferentially on advanced PD participants)]
Short Description of Instrument
The Movement Disorder Society-revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was developed and clinimetrically tested prior to its 2008 presentation. The MDS-UPDRS has four parts: Part I (non-motor experiences of daily living), Part II (motor experiences of daily living), Part III (motor examination) and Part IV (motor complications).
Part I has two components: IA concerning a number of behaviors that are assessed by the investigator with all pertinent information from patients and caregivers and IB that is completed by the patient with or without the aid of the caregiver, but independently of the investigator.
Part II is designed to be a self-administered questionnaire like Part IB, but can be reviewed by the investigator to ensure completeness and clarity. Of note, the official versions of Part IA, Part IB and Part II of the MDS-UPDRS do not have separate on or off ratings, and an average or overall global scoring is applied. Individual programs or protocols have used the same questions and scored responses separately for on and off, but this application has not been validated.
Part III has instructions for the rater to give or demonstrate to the patient; it is completed by the rater.
Part IV integrates patient-derived information with the rater's clinical observations and judgments and is completed by the rater.
The scale has gained wide acceptance internationally, especially in clinical trials involving relatively early or mild PD. It does not necessarily replace the original UPDRS which may be preferred for studies needing to separate severe from extreme impairments as might be seen in end-stage assessments or palliative care protocols.
The scale has been translated in over 20 non-English officially tested and validated language versions.
Scoring and Psychometric Properties
Scoring: Each of the four Parts is considered a separate inventory of a pertinent domain of Parkinson's disease and the sum scores of each Part are meant to be reported separately without a Total MDS-UPDRS score. All items are rating from 0 or normal to 1 or slight to 2 or mild to 3 or moderate to 4 or severe with written anchors tailored to each item and each level of dysfunction. In contrast to the earlier UPDRS, separately considered in the Comment Data Elements program, the MDS-UPDRS is calibrated specifically to detect very mild impairment and disability (insertion of a new rating option of "slight" for rating "1" and places less emphasis on distinction between severe or extreme impairments collapsing those into "4".
Psychometric Properties: The MDS-UPDRS items were tested clinimetrically within the context of scale validation of each part rather than testing each item. Validity, sensitivity to change, and reliability are not specifically reported for each item, although item selection was accomplished in a Delphi manner that included consultation with experts in movement disorders and testing in patient/caregiver focus groups. Differential item functioning (DIF) analysis was performed on a sample of more than 5,000 ratings. Most items showed no gender, age or race/ethnicity DIF, and when DIF was identified, the magnitude statistic was always in the 'Negligible" range with designated "minimal scale level impact." The maximal number of missing values has been explored for each Part, and there is recent evidence that Part III (Motor Examination) can be analyzed as a multidimensional assessment of motor function. Validated conversion formulas to transpose older UPDRS scores to MDS-UPDRS Part III values have been constructed as well as comparable formulas for the clinical categorization of "tremor predominant" and "Postural Instability/Gait Difficulty" phenotypes.
Key Reference:
Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N; Movement Disorder Society UPDRS Revision Task Force. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008 Nov 15;23(15):2129-70.
Additional References:
Gallagher DA, Goetz CG, Stebbins G, Lees AJ, Schrag A. Validation of the MDS-UPDRS Part I for nonmotor symptoms in Parkinson's disease. Mov Disord. 2012 Jan;27(1):79-83.
Goetz CG, Liu Y, Stebbins GT, Wang L, Tilley BC, Teresi JA, Merkitch D, Luo S. Gender-, age-, and race/ethnicity-based differential item functioning analysis of the movement disorder society-sponsored revision of the Unified Parkinson's disease rating scale. Mov Disord. 2016 Dec;31(12):1865-1873.
Goetz CG, Luo S, Wang L, Tilley BC, LaPelle NR, Stebbins GT. Handling missing values in the MDS-UPDRS. Mov Disord. 2015 Oct;30(12):1632-8.
Goetz CG, Stebbins GT, Tilley BC. Calibration of unified Parkinson's disease rating scale scores to Movement Disorder Society-unified Parkinson's disease rating scale scores. Mov Disord. 2012 Sep 1;27(10):1239-42.
Martinez-Martin P, Rodriguez-Blazquez C, Alvarez-Sanchez M, Arakaki T, Bergareche-Yarza A, Chade A, Garretto N, Gershanik O, Kurtis MM, Martinez-Castrillo JC, Mendoza-Rodriguez A, Moore HP, Rodriguez-Violante M, Singer C, Tilley BC, Huang J, Stebbins GT, Goetz CG. Expanded and independent validation of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). J Neurol. 2013 Jan;260(1):228-36.
Stebbins GT, Goetz CG, Burn DJ, Jankovic J, Khoo TK, Tilley BC. How to identify tremor dominant and postural instability/gait difficulty groups with the movement disorder society unified Parkinson's disease rating scale: comparison with the unified Parkinson's disease rating scale. Mov Disord. 2013 May;28(5):668-70.
Tosin MHS, Goetz CG, Luo S, Choi D, Stebbins GT. Item Response Theory Analysis of the MDS-UPDRS Motor Examination: Tremor vs. Nontremor Items. Mov Disord. 2020 Sep;35(9):1587-1595.
Document last updated August 2022