Rating scales of movement disorders

Chantale Branson MD (Dr. Branson of Boston Medical Center has no relevant financial relationships to disclose.)
Joseph Jankovic MD, editor. (

Dr. Jankovic, Director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine, received research and training funding from Allergan, F Hoffmann-La Roche, Medtronic Neuromodulation, Merz, Neurocrine  Biosciences, Nuvelution, Revance, and Teva and consulting/advisory board honorariums from Abide, Lundbeck, Retrophin, Parexel, Teva, and Allergan.

Originally released December 16, 1998; last updated June 4, 2018; expires June 4, 2021

This article includes discussion rating scales of movement disorders, rating scales, movement disorders, and Parkinson disease (anxiety). The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.


Measuring severity of disease and changes in disease state over time is critical for evaluating treatments and providing prognosis. When evaluating new treatments in clinical trials or comparing symptoms across time, methods of assessment need to be employed to ensure that we are improving patients and providing accurate information while minimizing harm. Detecting changes in disease commonly relies on changes in rating scales as a surrogate marker for changes in underlying disease processes. Rating scales also provide a standardized method of characterizing disease such that they can be reliably used by physicians worldwide for clinical and research purposes. In this article, the author provides an introduction to several of the rating scales that have been used to quantify specific involuntary movements (eg, tremor, chorea) or specific disease entities characterized by involuntary movements (eg, Huntington disease, Parkinson disease). Scales for each of the following involuntary movements or diseases are discussed: Parkinson disease, tics, chorea, dystonia, myoclonus, ataxia, tremor, drug-induced dyskinesia, and gait and balance in any movement disorder. The scales are summarized and presented in the text or linked to another site. The uses, reliability, validity, and limitations of each scale are discussed using current published evaluations. There are numerous scales available; however, the ones discussed are the ones that have been most commonly used and thoroughly tested. This article also reflects the most updated revisions and critiques of these scales.

Key points


• The ability to measure movement disorder characteristics over time allows for comparability of outcomes, helps with the interpretation of results, and minimizes errors of measurement.


• The ability of scales to produce consistent results and, therefore, to be useful instruments in monitoring patients and conducting research, depends on their psychometric properties.


• Rating scales in movement disorders focus on 2 primary concepts of dysfunction: impairment and disability.


• Items rated by the investigator and based on the neurologic examination assess impairment and relate to objective deficits.


• Interviews that involve the patient's, the caregiver's, and the investigator's assessments of activities of daily living or quality of life rate disability and, thus, assess the impact of the disease on daily function.

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