Three PD rating scales are widely used to rate the stage of PD. It is important for dental providers to realize these scales stage the disease at “a given moment in time” and individuals’ scores can vary from day-to-day or even hour-to-hour.
- The Unified Parkinson Disease Rating Scale measures (1) mental functioning, behavior, and mood; (2) activities of daily living, (3) motor function, and (4) complications. Scores range from 0 to 195, with higher scores indicating greater disability. Although widely used, this scale is very complicated and would not be a good fit for most dental practices.
- The Schwab and England Activities of Daily Living Scale36 (Table 1) measures the abilities of individuals with PD relative to their complete independence. The scale stages the disease from 0% (vegetative state) to 100% (completely independent). This scale is relatively simple and could be utilized by dental practices.
- The Hoehn and Yahr Scale (Table 2) measures motor symptoms to determine the level of disease.37 It is important for dental providers to recognize this scale is not linear. The amount of time spent in each stage varies from patient-to-patient and is different for each level. Patients may begin at stage II if involvement is generalized or bilateral. They may not reach stage V. Stages do not represent specific amounts of brain pathology.38 A modified form of this scale, that divides the disease into smaller increments, is also available. This scale is also relatively simple and could be utilized by dental practices.