MDS-UPDRS

What is a Movement Disorder Society-Sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS)?

Similar to the Unified Parkinson's Disease Rating Scale (UPDRS), the Movement Disorder Society-Sponsored Parkinson's Disease Rating Scale (MDS-UPDRS) is a rating tool a practitioner can use to measure a patient's Parkinson's disease severity and progression. However, there are two major differences between the two tests. 

The first difference is that the MDS-UPDRS is a modified version developed by the MDS review task force. In this version, they address problematic sections and shortcomings in the UPDRS by including nonmotor symptoms, differentiating mild signs and symptoms of Parkinson's better, and providing clearer instructions for the patient, their caregiver, and the rater. Between the two rating scales, this one is the better choice.

The second is that the updated and modified version includes, changes, removes, and moves certain sections around. Here's a list of the sections concerning Parkinson's disease highlighted by the MDS-UPDRS:

• Non-motor experiences of daily living (nM-EDL)
• Motor experiences of daily living (M-EDL)
• Motor examination
• Motor complications (which include motor fluctuations and movement disorders)

The nM-EDL and M-EDL comprise the daily living scale portion of this assessment.

The original had six sections:

• Mentation, behavior, and mood
• Activities of daily living
• Motor examination
• Complications of therapy in the past week
• Modified Hoehn and Yahr staging
• Schwab and England Activities of Daily Living Scale

The nM-EDL and M-EDL comprise the daily living scale portion of this assessment.

As for scoring, MDS-UPDRS follows most of the process of calculating the regular UPDRS total score. To refresh your memory, raters will score 0 to 4, with 0 being the highest and 4 being the lowest. If it's impossible to test a patient, there's also a “UR” option or “unable to rate.”

How does this MDS-UPDRS Scale work?

Planning to use the MDS-UPDRS Scale in your practice? Read below for a step-by-step guide on how to use and download our digitally editable and printable template. 

Step 1: Download the template

You can access and download our template by clicking “Use Template” or “Download Template” in this guide or by searching “MDS-UPDRS” in Carepatron's template library on the website or app. 

Step 2: Conduct the test

For the sections wherein the rater has to score, the rater must follow the provided instructions per item; ask the patient the provided questions or instruct them to do certain exercises; listen to the patient (and caregiver's) answers or observe the patient's movement, and as a final step, tick the appropriate score depending on the matching description. Here's a list of the corresponding sections described:

• Part IA: Complex behaviors, Non-motor aspects of experiences of daily living (nM-EDL)
• Motor examination
• Motor complications

Meanwhile, in the sections where the patient has to answer on their own or with the help of their caregiver, the patient must read, understand, think hard about the answers to the questions, and tick the appropriate score depending on their responses. Here's a list of the corresponding sections described: 

• Part IB: Non-motor aspects of experiences of daily living (nM-EDL)
• Motor aspects of experiences of daily living (M-EDL)

If you're worried that you may not remember this step, don't worry. The template comes with comprehensive instructions and an indication of which sections must be completed by the rater or the patient and their caregiver. 

Step 3: Total scores and proceed with interpretation

When the rater and patient complete the test and have totaled the scores per section, the expert may proceed with their interpretation. 

Scoring

All sections shall be scored using the provided 0-4 rating scale. To obtain a score per item, the rater must observe the patient's response to given instructions or have the patient (and their caregiver) answer the questions provided. 

Certain items may also require you to do calculations. The items are as follows: time spent with dyskinesias, time spent in the off-state, functional impact of dyskinesias, and painful off-state dystonia.

Add the item scores together to get the total score per section used for interpretation. For an easier time, you may record all the scores you've gotten in the tables at the end of the template. 

When to use these MDS-UPDRS tests?

Similarly to the UPDRS, the MDS-UPDRS can be used in both clinical and research settings by practitioners and researchers focusing primarily on Parkinson's disease. To be more specific, they may use this scale and template to:

• Provide a disease prognosis to the patient
• Monitor a patient's response to a treatment or management plan for the signs and symptoms they're experiencing because of Parkinson's disease
• Evaluate if a researcher's therapies under clinical trials are effective or not

In addition, practitioners, researchers, and even caregivers may use the scale and template to identify the aspects of the patient's life that need further observation or intervention. 

Who is this MDS-Unified Parkinson's Disease Rating Scale PDF for?

Like the UPDRS, any practitioner or researcher focusing on and specializing in Parkinson's disease will find a PDF copy of the MDS-Unified Parkinson's Disease Rating Scale beneficial. Aside from these, any professional caring for patients with Parkinson's disease will find this template useful. 

Below is a list of who the MDS-UPDRS is specifically for:

• General Practitioners
• Geriatricians
• Neurologists
• Therapists (physio, speech, occupation, language)
• Parkinson's Disease nurses

Although it's mentioned that caregivers may find this template helpful, it's important to note and remember that they may not be considered a rater and can only participate in the self-questionnaire portion of the test or when the practitioner asks for more information that the patient can't provide. 

Benefits of using the MDS-UPDRS

Using the MDS-UPDRS in practice can offer several benefits to healthcare practitioners, including:

Comprehensive evaluation

Compared to the UPDRS, the MDS-UPDRS is more comprehensive and includes detailed instructions on conducting and even scoring the test in the template itself. 

Establish baselines for comparison

This scale can also be used as a baseline once the disease has been recognized. One only has to note down the date of the diagnosis so that the document may be considered the starting point. 

Tracks progression

To formulate an effective treatment or management plan, one has to check the prognosis and progression of a disease. With our template, one can do that, especially if the practitioner conducts this test often or after the patient participates in disease-modifying therapies for a certain period. 

Know more about a patient's condition

With this test being more comprehensive, since the creators have addressed the shortcomings of the UPDRS, practitioners can know more about their patient's conditions, including the more subtle signs and symptoms that the UPDRS doesn't consider or identify. 

Fully digital 

A fully digital MDS-UPDRS scale template can benefit the raters, patients, and practitioners who will use this as a resource. It saves time, money, and effort, is easily accessible, and can be stored in a secure EHR such as Carepatron.