The Hoehn and Yahr Rating Scale for Parkinson’s Disease
Parkinson’s disease (PD) is a complicated disease in which a number of theoretical and practical considerations on how best to assess the clinical deficit have been published [1–3]. In addition, the utilization of levodopa or dopamine agonists produces a large array of side effects which superimpose upon the motor fluctuations frequently seen in these patients, complicating even more the precise evaluation of disability. Since the introduction of levodopa, a number of clinical rating systems have been suggested and continue to be developed, suggesting that no single scale is completely satisfactory (Table 1). These scales attempt to measure symptoms, signs, and/or functional disability. Subjective methods of assessment of PD include: (a) clinical rating scale, (b) self-rating scale, and (c) functional disability. Simple objective methods include: (a) gait measurements, (b) finger movements, (c) reaction time (computerized), and (d) movement time (computerized). In the present paper, it is our purpose to review the Hoehn and Yahr scale , published in 1967, which is the most popular scale used worldwide for the staging of the functional disability associated with Parkinson’s disease.
KeywordsFunctional Disability Motor Fluctuation Levodopa Therapy Clinical Rating Scale Axial Involvement
Unable to display preview. Download preview PDF.
- 2.Larsen AT, LeWitt PA, Came DB (1983) Theoretical and practical issues in assessment of deficits and therapy in parkinsonism. In: Calne DB, Horowski R, McDonald RJ, Wittke W (eds) Lisuride and other dopamine agonists. Raven, New York, pp 363–373Google Scholar
- 3.Ward CD, Sanes JN, Dambriosia JM, Calne DB (1983) Methods for evaluating treatment in Parkinson’s disease. In: Fahn S, Calne DB, Shoulson I (eds) Experimental therapeutics of movement disorders. Raven, New York, pp 1–7 (Advances in neurology, vol 37)Google Scholar
- 5.Fahn S (1975) “On off” phenomenon with levodopa therapy in parkinsonism. Neurology (Minneapolis) 24:431–444Google Scholar
- 6.LeWitt PA, Chase TN (1983) “On off” effects: the new challenge in parkinsonism. TINS 6:1–4Google Scholar
- 7.Nausieda PA, Glantz R, Weber S, Baum R, Klawans HL (1984) Psychiatric complications of levodopa therapy of Parkinson’s disease. In: Hassler RG, Christ JF (eds) Advances in neurology, vol 40. Raven, New York, pp 271–277Google Scholar
- 8.Korczyn AD, Inzelberg R, Treves M, Reider I, Rabey JM (1986) Dementia of Parkinson’s disease. In: Yahr MD, Bergmann KJ (eds) Parkinson’s disease. Raven, New York, pp 399–403 (Advances in neurology, vol 45)Google Scholar
- 11.Fahn S, Elton RL and members of the UPDRS development committee (1987) Unified Parkinson’s disease rating scale. In: Fahn S, Marsden CD, Goldstein M, Calne DB (eds) Recent developments in Parkinson’s disease, vol 2. Macmillan, New York, pp 153–163Google Scholar
- 12.Karnofsky DA, Burchenal JH, Armistead GC, Southam CM, Bernstein JL, Craver IF, Rhoads CP (1951) Triethylene nealamine in the treatment of neoplastic disease. Arch Intern Med 87:477–516Google Scholar
- 15.Webster DD (1968) Critical analysis of the disability in Parkinson’s disease. Mod Treatment 5:257–282Google Scholar
- 18.Duvoisin RC (1970) The evaluation of extrapyramidal disease. In: De Ajuriagerra J (ed) Monoamines, noyaux gris centraux et syndrome de Parkinson. Masson, Paris, pp 313–325Google Scholar
- 19.Parkes JD, Zilkha KJ, Calver DM, Knill-Jones RP (1970) Controlled trial of amantadine hydrochloride in Parkinson’s disease. Lancet I:259–262Google Scholar
- 29.Lieberman A, Dziatolowski M, Gopinathan G, Kupersmith M, Neophytides A, Korein J (1980) Evaluation of Parkinson’s disease. In: Goldstein M (ed) Ergot compounds and brain function: neuro-endocrine and neuropsychiatric aspects. Raven, New York, pp 277–286Google Scholar