Sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): process, format, and clinimetric testing plan

University of Toronto, Toronto, Ontario, Canada
Movement Disorders (Impact Factor: 5.68). 01/2007; 22(1):41-7. DOI: 10.1002/mds.21198
Source: PubMed


This article presents the revision process, major innovations, and clinimetric testing program for the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (UPDRS), known as the MDS-UPDRS. The UPDRS is the most widely used scale for the clinical study of Parkinson's disease (PD). The MDS previously organized a critique of the UPDRS, which cited many strengths, but recommended revision of the scale to accommodate new advances and to resolve problematic areas. An MDS-UPDRS committee prepared the revision using the recommendations of the published critique of the scale. Subcommittees developed new material that was reviewed by the entire committee. A 1-day face-to-face committee meeting was organized to resolve areas of debate and to arrive at a working draft ready for clinimetric testing. The MDS-UPDRS retains the UPDRS structure of four parts with a total summed score, but the parts have been modified to provide a section that integrates nonmotor elements of PD: I, Nonmotor Experiences of Daily Living; II, Motor Experiences of Daily Living; III, Motor Examination; and IV, Motor Complications. All items have five response options with uniform anchors of 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe. Several questions in Part I and all of Part II are written as a patient/caregiver questionnaire, so that the total rater time should remain approximately 30 minutes. Detailed instructions for testing and data acquisition accompany the MDS-UPDRS in order to increase uniform usage. Multiple language editions are planned. A three-part clinimetric program will provide testing of reliability, validity, and responsiveness to interventions. Although the MDS-UPDRS will not be published until it has successfully passed clinimetric testing, explanation of the process, key changes, and clinimetric programs allow clinicians and researchers to understand and participate in the revision process.

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    • "Several scales have been developed to (1) assess the risk of developing PD psychosis (Chaudhuri et al. 2007) or (2) to confirm the presence of the condition or (3) to grade its severity. Some of these scales are integrated as sub-scores into more general PD scales, such as the MDS-UPDRS (Goetz et al. 2007), while others, such as the Parkinson "
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    ABSTRACT: Psychosis in Parkinson's disease (PD) is a frequent condition affecting >20 % of all PD patients. It is characterized by vivid dreams, nightmares, illusions, delusions and mostly visual hallucinations. Typically psychosis occurs in the late stage of PD, affecting up to 70 % of the patients following a disease duration of 20 years or more, and can severely interfere with the care of the patients, especially if the patients develop delusions. Psychosis is the principal cause of admission to a nursing home for PD patients. Hence, preemptive identification of risk factors, and avoidance and elimination of triggers are most important measures against psychosis in PD patients. Secondarily, pharmaceutical measures are being undertaken successively, including simplification of medication regimes, discontinuation of non-essential CNS-active drugs, ordered reduction of antiparkinsonian drugs, addition of cholesterinase inhibitors in cognitively impaired patients, and finally addition of antipsychotic medication with limited parkinsonian side effects. As psychosis in PD is a frequent and important problem, we set out to write a state-of-the-art guideline for its identification and treatment.
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    • "Motor symptoms in the PD patient group were rated using the Unified Parkinson Disease Rating Scale (UPDRS III) motor score [18]. Clinical stage was rated with the Hoehn and Yahr (HY) stage [19]. "
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    • "13 (freezing) and 3.11 (FOG) of the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), which is the gold standard to assess Parkinsonian symptoms [20] "
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    ABSTRACT: Background. Freezing of Gait (FOG) is a disabling parkinsonian symptom. The Freezing of Gait Questionnaire (FOG-Q) reliably detects FOG in patients with Parkinson's disease (PD). Objectives. The aim of this study was to develop a German translated version of the FOG-Q and to assess its validity. Methods. The translation was accomplished using forward-backward-translation. The construct validity of the FOG-Q was examined in twenty-seven German native speaking PD patients. Convergent validity was assessed by correlating the FOG-Q with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) II-III, the Parkinson Disease Questionnaire 39 (PDQ-39), and the Timed Up and Go Test (TUG). Divergent validity was assessed by correlating the FOG-Q with the MDS-UPDRS I. The internal consistency was measured using Cronbach's alpha (Cí µí»¼). Results. A good internal structure of the FOG-Q was found (Cí µí»¼ = 0.83). Significant moderate correlations between the FOG-Q and the MDS-UPDRS item 2.13 (freezing) (í µí±Ÿ í µí± = 0.568, í µí±ƒ = 0.002) and between the FOG-Q and the PDQ-39 subscale mobility (í µí±Ÿ í µí± = 0.516, í µí±ƒ = 0.006) were found. The lack of correlation with the MDS-UPDRS I demonstrated good divergent validity. Conclusion. The German FOG-Q is a valid tool to assess FOG in German native speaking PD patients.
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