Caroline Cassels

July 18, 2007

July 18, 2007 — Within the next year, clinicians can expect a new and improved Unified Parkinson's Disease Rating Scale (UPDRS), the current gold standard and most widely used clinical assessment tool for Parkinson's disease (PD) in the world.

The process to revamp the UPDRS began in 2001 when, after a critique of the scale, the Movement Disorder Society officially endorsed the development of a new version of the UPDRS that would better reflect the myriad of nonmotor symptoms experienced by PD patients, particularly in the early stages of the disease.

Christopher Goetz, MD, from Rush University Medical Center, in Chicago, Illinois, led the process and recently provided a progress report at the 11th International Congress of Parkinson's Disease and Movement Disorders, in Istanbul, where he presented an initial comparison of the original (UPDRS) and new (MDS-UPDRS) versions in a population of 809 PD patients.

"Over the past 20 years, the scope of Parkinson's disease has expanded, especially in the recognition of early nonmotor symptoms such as apathy, fatigue, and impulsive behaviors related to dopamine dysregulation syndrome. As a result, the Movement Disorder Society set out to revise the UPDRS, which is still an excellent scale, to reflect these changes," Dr. Goetz told Medscape in a recent follow-up interview.

High Correlation Between Old And New Scales

Experienced study coordinators and movement-disorder physicians using both scales assessed all study subjects — two-thirds of whom were men. The majority of subjects (675) were white, but minorities, which included Native Americans, Asians, and African Americans, made up 16.6% (134) of the total study population.

A total of 741 subjects were receiving treatment with levodopa or other dopaminergic alone or in combination with another symptomatic treatment, and 66 were untreated.

"In this first analysis we found a very, very high correlation between the old and the new [UPDRS], which is very encouraging," he said.

Dr. Goetz added that patient response to the new scale has been very positive. "One of the nice things about this [new] scale is that we've revamped many of the questions, so patients are able to answer the questions themselves, a change that has been very well received," he said.

Almost Ready for Prime Time

However, he added, before the scale is ready for general distribution it still has to undergo further analyses. Nevertheless, Dr. Goetz said the project is on schedule and expected to be ready for formal presentation in 2008. Next steps also include translating the new scale into different languages to make it internationally accessible.

"My hope is this new scale will be adopted at an international level and will capture the gamut of problems that Parkinson's disease patients experience. In addition, we hope it will be responsive to various interventions, so we can better chart how patients respond to treatment, particularly in the early stages of their disease," he said.

11th International Congress of Parkinson's Disease and Movement Disorders: Oral Session 2. June 3-7, 2007.

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