Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: Status and recommendations The Movement Disorder Society Task Force on rating scales for Parkinson's disease

Abstract

The Movement Disorder Society Task Force for Rating Scales for Parkinson's disease (PD) prepared a critique of the Hoehn and Yahr scale (HY). Strengths of the HY scale include its wide utilization and acceptance. Progressively higher stages correlate with neuroimaging studies of dopaminergic loss, and high correlations exist between the HY scale and some standardized scales of motor impairment, disability, and quality of life. Weaknesses include the scale's mixing of impairment and disability and its non-linearity. Because the HY scale is weighted heavily toward postural instability as the primary index of disease severity, it does not capture completely impairments or disability from other motor features of PD and gives no information on nonmotor problems. Direct clinimetric testing of the HY scale has been very limited, but the scale fulfills at least some criteria for reliability and validity, especially for the midranges of the scale (Stages 2-4). Although a "modified HY scale" that includes 0.5 increments has been adopted widely, no clinimetric data are available on this adaptation. The Task Force recommends that: (1) the HY scale be used in its original form for demographic presentation of patient groups; (2) when the HY scale is used for group description, medians and ranges should be reported and analysis of changes should use nonparametric methods; (3) in research settings, the HY scale is useful primarily for defining inclusion/exclusion criteria; (4) to retain simplicity, clinicians should "rate what you see" and therefore incorporate comorbidities when assigning a HY stage; and (5) because of the wide usage of the modified HY scale with 0.5 increments, this adaptation warrants clinimetric testing. Without such testing, however, the original five-point scales should be maintained.

Specifically neuropathic Gaucher's mutations accelerate cognitive decline in Parkinson's

“…HY stage 3 marks the transition from mild to moderate disease with impaired balance. It is meaningful for patients because of fall risk and impact on quality of life 36. In this population, none of the four types of GBA mutations investigated was statistically significantly associated with progression to HY stage 3 compared to noncarriers, respectively, in the Cox proportional hazards model adjusted for sex and age at onset.…”

Facial emotion recognition in Parkinson's disease: A review and new hypotheses

“…Their conclusions would have been different in more severe cases. Even when disease severity was measured with the Unified Parkinson's Disease Rating Scale, regarded as more sensitive than Hoehn and Yahr staging,78, 79 results still diverged but seemed to be in favour of a positive correlation between disease severity and FER deficit 24, 64, 65, 67, 80, 81. PD progression is very heterogeneous and depends on several factors.…”

Increased bradykinesia in Parkinson’s disease with increased movement complexity: elbow flexion–extension movements

“…Three PD patients (1: male age 50, 2: male age 59, 3: female age 59), and three agematched control subjects (1: male age 50, 2: male 59, 3: female 60) participated in the experiments. One of the patients was classified as I (patient 1), and two were classified as II on the Hoehn and Yahr scale (Goetz et al 2004). A visual stimulus (LED flashing on) was provided at random intervals ranging from 3 to 4 s. On presentation of the stimulus, the subject was requested to perform the required movement, completing the action by pressing a button on the measurement box.…”