I. MENTATION,
BEHAVIOR AND MOOD
1. Intellectual
Impairment
0 = None.
1 = Mild. Consistent forgetfulness with partial recollection of events and no
other difficulties.
2 = Moderate memory loss, with disorientation and moderate difficulty handling
complex problems. Mild but definite impairment of function at home with need of
occasional prompting.
3 = Severe memory loss with disorientation for time and often to place. Severe
impairment in handling problems.
4 = Severe memory loss with orientation preserved to person only. Unable to
make judgements or solve problems. Requires much help with personal care.
Cannot be left alone at all.
2. Thought Disorder (Due to dementia or drug
intoxication) 0 = None.
1 = Vivid dreaming.
2 = "Benign" hallucinations with insight retained.
3 = Occasional to frequent
hallucinations or delusions; without insight; could interfere with daily
activities. 4 = Persistent hallucinations, delusions, or florrid psychosis. Not
able to care for self.
3. Depression
1 = Periods of sadness or
guilt greater than normal, never sustained for days or weeks.
2 = Sustained depression (1 week or more).
3 = Sustained depression with vegetative symptoms (insomnia, anorexia, weight
loss, loss of interest). 4 = Sustained depression with vegetative symptoms and
suicidal thoughts or intent.
4.
Motivation/Initiative
0 = Normal.
1 = Less assertive than usual; more passive.
2 = Loss of initiative or disinterest in elective (nonroutine) activities. 3 =
Loss of initiative or disinterest in day to day (routine) activities. 4 =
Withdrawn, complete loss of motivation.
II. ACTIVITIES OF
DAILY LIVING (for both "on" and "off")
5. Speech
0 = Normal.
1 = Mildly affected. No difficulty being understood.
2 = Moderately affected. Sometimes asked to repeat statements. 3 = Severely
affected. Frequently asked to repeat statements.
4 = Unintelligible most of the time.
6. Salivation
0 = Normal.
1 = Slight but definite excess of saliva in mouth; may have nighttime drooling.
2 = Moderately excessive saliva; may have minimal drooling.
3 = Marked excess of saliva with some drooling.
4 = Marked drooling, requires constant tissue or handkerchief.
7. Swallowing
0 = Normal.
1 = Rare choking.
2 = Occasional choking.
3 = Requires soft food.
4 = Requires NG tube or gastrotomy feeding.
8. Handwriting
0 = Normal.
1 = Slightly slow or small.
2 = Moderately slow or small; all words are legible. 3 = Severely affected; not
all words are legible.
4 = The majority of words are not legible.
9. Cutting food and
handling utensils
0 = Normal.
1 = Somewhat slow and clumsy, but no help needed.
2 = Can cut most foods, although clumsy and slow; some help needed. 3 = Food
must be cut by someone, but can still feed slowly.
4 = Needs to be fed.
10. Dressing
0 = Normal.
1 = Somewhat slow, but no help needed.
2 = Occasional assistance with buttoning, getting arms in sleeves. 3 =
Considerable help required, but can do some things alone.
4 = Helpless.
11. Hygiene
0 = Normal.
1 = Somewhat slow, but no help needed.
2 = Needs help to shower or bathe; or very slow in hygienic care.
3 = Requires assistance for washing, brushing teeth, combing hair, going to
bathroom. 4 = Foley catheter or other mechanical aids.
12. Turning in bed and
adjusting bed clothes
0 = Normal.
1 = Somewhat slow and clumsy, but no help needed.
2 = Can turn alone or adjust sheets, but with great difficulty. 3 = Can
initiate, but not turn or adjust sheets alone.
4 = Helpless.
13. Falling (unrelated
to freezing)
0 = None.
1 = Rare falling.
2 = Occasionally falls, less than once per day. 3 = Falls an average of once
daily.
4 = Falls more than once daily.
14. Freezing when
walking
0 = None.
1 = Rare freezing when walking; may have starthesitation. 2 = Occasional
freezing when walking.
3 = Frequent freezing. Occasionally falls from freezing.
4 = Frequent falls from freezing.
15. Walking
0 = Normal.
1 = Mild difficulty. May not swing arms or may tend to drag leg. 2 = Moderate
difficulty, but requires little or no assistance.
3 = Severe disturbance of walking, requiring assistance.
4 = Cannot walk at all, even with assistance.
16. Tremor (Symptomatic complaint of tremor in
any part of body.) 0 = Absent.
1 = Slight and infrequently present.
2 = Moderate; bothersome to patient.
3 = Severe; interferes
with many activities. 4 = Marked; interferes with most activities.
17. Sensory complaints
related to parkinsonism
0 = None.
1 = Occasionally has numbness, tingling, or mild aching.
2 = Frequently has numbness, tingling, or aching; not distressing. 3 = Frequent
painful sensations.
4 = Excruciating pain.
III. MOTOR
EXAMINATION
18. Speech
0 = Normal.
1 = Slight loss of expression, diction and/or volume.
2 = Monotone, slurred but understandable; moderately impaired. 3 = Marked
impairment, difficult to understand.
4 = Unintelligible.
19. Facial Expression
0 = Normal.
1 = Minimal hypomimia, could be normal "Poker Face".
2 = Slight but definitely abnormal diminution of facial expression
3 = Moderate hypomimia; lips parted some of the time.
4 = Masked or fixed facies with severe or complete loss of facial expression;
lips parted 1/4 inch or more.
20. Tremor at rest (head, upper and lower extremities)
0 = Absent.
1 = Slight and infrequently present.
2 = Mild in amplitude and persistent. Or moderate in amplitude, but only
intermittently present. 3 = Moderate in amplitude and present most of the time.
4 = Marked in amplitude
and present most of the time.
21. Action or Postural
Tremor of hands
0 = Absent.
1 = Slight; present with action.
2 = Moderate in amplitude, present with action.
3 = Moderate in amplitude with posture holding as well as action. 4 = Marked in
amplitude; interferes with feeding.
22. Rigidity (Judged on passive movement of
major joints with patient relaxed in sitting position. Cogwheeling to be
ignored.)
0 = Absent.
1 = Slight or detectable only when activated by mirror or other movements.
2 = Mild to moderate.
3 = Marked, but full range of motion easily achieved. 4 = Severe, range of
motion achieved with difficulty.
23. Finger Taps (Patient taps thumb with index
finger in rapid succession.)
0 = Normal.
1 = Mild slowing and/or reduction in amplitude.
2 = Moderately impaired. Definite and early fatiguing. May have occasional
arrests in movement.
3 = Severely impaired. Frequent hesitation in initiating movements or arrests
in ongoing movement. 4 = Can barely perform the task.
24. Hand Movements (Patient opens and closes hands in
rapid succesion.)
0 = Normal.
1 = Mild slowing and/or reduction in amplitude.
2 = Moderately impaired. Definite and early fatiguing. May have occasional
arrests in movement.
3 = Severely impaired. Frequent hesitation in initiating movements or arrests
in ongoing movement. 4 = Can barely perform the task.
25. Rapid Alternating
Movements of Hands (Pronation-supination
movements of hands, vertically and horizontally, with as large an amplitude as
possible, both hands simultaneously.)
0 = Normal.
1 = Mild slowing and/or reduction in amplitude.
2 = Moderately impaired.
Definite and early fatiguing. May have occasional arrests in movement.
3 = Severely impaired. Frequent hesitation in initiating movements or arrests
in ongoing movement. 4 = Can barely perform the task.
26. Leg Agility (Patient taps heel on the ground in
rapid succession picking up entire leg. Amplitude should be at least 3 inches.)
0 = Normal.
1 = Mild slowing and/or reduction in amplitude.
2 = Moderately impaired.
Definite and early fatiguing. May have occasional arrests in movement.
3 = Severely impaired. Frequent hesitation in initiating movements or arrests
in ongoing movement. 4 = Can barely perform the task.
27. Arising from Chair (Patient attempts to rise from a
straightbacked chair, with arms folded across chest.) 0 = Normal.
1 = Slow; or may need more than one attempt.
2 = Pushes self up from arms of seat.
3 = Tends to fall back and
may have to try more than one time, but can get up without help. 4 = Unable to
arise without help.
28. Posture
0 = Normal erect.
1 = Not quite erect, slightly stooped posture; could be normal for older
person.
2 = Moderately stooped posture, definitely abnormal; can be slightly leaning to
one side. 3 = Severely stooped posture with kyphosis; can be moderately leaning
to one side.
4 = Marked flexion with extreme abnormality of posture.
29. Gait
0 = Normal.
1 = Walks slowly, may shuffle with short steps, but no festination (hastening
steps) or propulsion.
2 = Walks with difficulty, but requires little or no assistance; may have some
festination, short steps, or propulsion. 3 = Severe disturbance of gait,
requiring assistance.
4 = Cannot walk at all, even with assistance.
30. Postural Stability (Response to sudden, strong
posterior displacement produced by pull on shoulders while patient erect with
eyes open and feet slightly apart. Patient is prepared.)
0 = Normal.
1 = Retropulsion, but recovers unaided.
2 = Absence of postural
response; would fall if not caught by examiner. 3 = Very unstable, tends to
lose balance spontaneously.
4 = Unable to stand without assistance.
31. Body Bradykinesia
and Hypokinesia (Combining
slowness, hesitancy, decreased armswing, small amplitude, and poverty of
movement in general.)
0 = None.
1 = Minimal slowness, giving movement a deliberate character; could be normal
for some persons. Possibly reduced amplitude.
2 = Mild degree of
slowness and poverty of movement which is definitely abnormal. Alternatively,
some reduced amplitude.
3 = Moderate slowness, poverty or small amplitude of movement.
4 = Marked slowness, poverty or small amplitude of movement.
IV. COMPLICATIONS OF
THERAPY (In the past week)
A. DYSKINESIAS
32. Duration: What
proportion of the waking day are dyskinesias present? (Historical information.) 0 = None
1 = 1-25% of day.
2 = 26-50% of day.
3 = 51-75% of day. 4 =
76-100% of day.
33. Disability: How
disabling are the dyskinesias? (Historical information; may be modified by office
examination.) 0 = Not disabling.
1 = Mildly disabling.
2 = Moderately disabling.
3 = Severely disabling.
4 = Completely disabled.
34. Painful
Dyskinesias: How painful are the dyskinesias?
0 = No painful
dyskinesias. 1 = Slight.
2 = Moderate.
3 = Severe.
4 = Marked.
35. Presence of Early
Morning Dystonia (Historical
information.) 0 = No
1 = Yes
B. CLINICAL
FLUCTUATIONS
36. Are "off"
periods predictable?
0 = No 1 = Yes
37. Are "off"
periods unpredictable?
0 = No 1 = Yes
38. Do "off"
periods come on suddenly, within a few seconds?
0 = No 1 = Yes
39. What proportion of
the waking day is the patient "off" on average?
0 = None
1 = 1-25% of day.
2 = 26-50% of day. 3 = 51-75% of day. 4 = 76-100% of day.
C. OTHER COMPLICATIONS
40. Does the patient
have anorexia, nausea, or vomiting?
0 = No 1 = Yes
41. Any sleep
disturbances, such as insomnia or hypersomnolence?
0 = No 1 = Yes
42. Does the patient
have symptomatic orthostasis?
( Record the patient's
blood pressure, height and weight on the scoring form) 0 = No
1 = Yes
V. MODIFIED HOEHN
AND YAHR STAGING
STAGE 0 = No signs of
disease.
STAGE 1 = Unilateral disease.
STAGE 1.5 = Unilateral plus axial involvement.
STAGE 2 = Bilateral disease, without impairment of balance.
STAGE 2.5 = Mild bilateral disease, with recovery on pull test.
STAGE 3 = Mild to moderate bilateral disease; some postural instability;
physically independent. STAGE 4 = Severe disability; still able to walk or
stand unassisted.
STAGE 5 = Wheelchair bound or bedridden unless aided.
VI. SCHWAB AND
ENGLAND ACTIVITIES OF DAILY LIVING SCALE
100% = Completely
independent. Able to do all chores without slowness, difficulty or impairment.
Essentially normal. Unaware of any difficulty.
90% = Completely independent. Able to do all chores with some degree of
slowness, difficulty and impairment. Might take twice as long. Beginning to be
aware of difficulty.
80% = Completely
independent in most chores. Takes twice as long. Conscious of difficulty and
slowness.
70% = Not completely independent. More difficulty with some chores. Three to
four times as long in some. Must spend a large part of the day with chores.
60% = Some dependency. Can do most chores, but exceedingly slowly and with much
effort. Errors; some impossible. 50% = More dependent. Help with half, slower,
etc. Difficulty with everything.
40% = Very dependent. Can assist with all chores, but few alone.
30% = With effort, now and then does a few chores alone or begins alone. Much
help needed.
20% = Nothing alone. Can be a slight help with some chores. Severe invalid.
10% = Totally dependent, helpless. Complete invalid.
0% = Vegetative functions such as swallowing, bladder and bowel functions are
not functioning. Bedridden.
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