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Movement Disorder Society-Sponsored Unified Parkinson’s Disease Rating Scale Revision

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The MDS-UPDRS is a comprehensive assessment designed to monitor the burden and extent of Parkinson’s disease across the longitudinal disease course and provide a clinical endpoint in therapy trials.


Area of Assessment

Activities of Daily Living
Balance – Non-vestibular
Functional Mobility
Life Participation
Quality of Life
Upper Extremity Function

Administration Mode

Paper & Pencil


Not Free

Actual Cost


Cost Description

Individual/personal use: Free
Industry use: $20,000
Government or non-profit organization funded use (ex: sponsored clinical trial or industry funded publication): $1,000

Key Descriptions

  • The Unified Parkinson’s Disease Rating Scale (UPDRS) was originally developed in the 1980’s and had become the most widely used clinical rating scale for Parkinson’s Disease (PD). In 2001, the Movement Disorder Society (MDS) sponsored a critique of the UPDRS and developed a new version of the scale termed the MDS-UPDRS in 2007. The MDS-UPDRS retained the strengths of the original scale but resolved identified problems outlined in the critique particularly a lack of consistent anchors among subscales as well as low emphasis on non-motor features of PD.
  • The MDS-UPDRS has 4 parts with a total summed score.
  • Part I: non-motor experiences of daily living (13 questions). Part I has 2 components:
    1) Part IA concerns a number of behaviors that are assessed by the investigator with all pertinent information from patients and caregivers.
    2) Part IB is completed by the patient with or without the aid of the caregiver but independently of the investigator. It can, however be reviewed by the rater to ensure that all questions are answered clearly and the rater can help explain any ambiguities.
  • Part II: motor experiences of daily living (13 questions). Part II is designed to be a self-administered questionnaire similar to Part IB but can be reviewed by the investigator to ensure completeness and clarity.
  • Part III: motor examination (33 scores based on 18 questions with several right, left or other body distributions scores). Part III has instructions for the rater to give or demonstrate to the patient and is completed by the rater.
  • Part IV: motor complications (6 questions). Part IV has instructions for the rater and also instructions to be read to the patient. This part integrates patient derived information with the rater’s clinical observations and judgments and is completed by the rater.
  • Parts IA, IB and II of the MDS-UPDRS do not have separate ON or OFF ratings however for individual programs or protocols the same questions can be used separately during ON and OFF times. ON and OFF definitions are provided to ensure uniformity among raters and the score sheets documents the ON/OFF status associated with the Part III assessment.
  • All items have 5 response options with uniform anchors of
    0 = normal
    1 = slight (symptoms/signs with sufficiently low frequency or intensity to cause no impact on function)
    2 = mild (symptoms/signs of frequency or intensity sufficient to cause a modest impact on function
    3 = moderate (symptoms/signs sufficiently frequent or intense to impact considerably, but not prevent function)
    4 = severe (symptoms/signs that prevent function)
    Higher scores indicate greater impact of PD symptoms.

Number of Items


Equipment Required

  • Pen/Paper

Time to Administer

30 minutes

Required Training

Training Course

Age Ranges


18 - 64


Elderly Adult

65 +


Instrument Reviewers

Initially reviewed by Alicia Esposito, PT, DPT, NCS and the PD EDGE task force of the Neurology Section of the APTA in April of 2013.

ICF Domain

Body Function

Measurement Domain

Activities of Daily Living

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:




Highly Recommend




Reasonable to use, but limited study in target group / Unable to Recommend


Not Recommended


Recommendations Based on Parkinson Disease Hoehn and Yahr stage:














Recommendations for entry-level physical therapy education and use in research:


Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)





Not reported


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Parkinson's Disease

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Normative Data

Parkinson’s Disease:

(Goetz et al, 2008)

  • Mean Scores (Standard Deviation)
    • Part I: 11.5(7)
    • Part II: 16.0(10)
    • Part III: 36.8(18.4)
    • Part IV: 4.0(4.2)
    • Total mean score: 68.4(32.8)

Internal Consistency

Parkinson’s Disease:

(Goetz et al, 2008)

  • Internal consistency was computed for each part of the MDS-UPDRS
    • Part I: Adequate (α = 0.79)
    • Part II: Excellent (α = 0.90)
    • Part III: Excellent (α = 0.93)
    • Part IV: Adequate (α = 0.79)


(Gallagher et al, 2012)

  • Excellent internal consistency of Part I total score: 0.85
  • Poor internal consistency of depression/anxiety/apathy factor score: 0.69
  • Excellent internal consistency of other non-motor factor score: 0.82

Criterion Validity (Predictive/Concurrent)

Concurrent Validity


Parkinson’s Disease:

(Goetz et al, 2008)


Comparison between the original UPDRS and the MDS-UPDRS:

  • Concurrent validity based on total score: Excellent (r = 0.96)

  • Concurrent validity between the individual parts of the original UPDRS and the MDS-UPDRS

    • Part I: Excellent (r = 0.76)

    • Part II: Excellent (r = 0.92)

    • Part III: Excellent (r = 0.96)

    • Part IV (sum of items 32-39 covering dyskinesias and motor fluctuations on the UPDRS vs. total part IV from the MDS-UPDRS): Excellent (r = 0.89)


(Gallagher et al, 2012)

  • Excellent concurrent validity based on original UPDRS Part I (r = 0.81, p < 0.001)

Floor/Ceiling Effects

Parkinson’s Disease:

(Goetz et al, 2008)

  • Part I: Adequate (lowest 0.1%/highest 0.8%)
  • Part II: Adequate (lowest 0.1%/highest 0.7%)
  • Part III: Adequate (lowest 0.1%/highest 0.2%)
  • Part IV: Poor - expected floor effect but no ceiling effect (lowest 36.7%/highest 0.1%)


(Gallagher et al, 2012)

  • Part I: Adequate floor effects: 2%
  • Part I: Excellent: no ceiling effects


Gallagher, D. A., Goetz, C. G., et al. (2012). "Validation of the MDS-UPDRS Part I for nonmotor symptoms in Parkinson's disease." Mov Disord 27(1): 79-83. Find it on PubMed

Goetz, C. G., Nutt, J. G., et al. (2009). "Teaching program for the Unified Dyskinesia Rating Scale." Mov Disord 24(9): 1296-1298. Find it on PubMed

Goetz, C. G., Tilley, B. C., et al. (2008). "Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results." Mov Disord 23(15): 2129-2170. Find it on PubMed