An Investigation into the Use and Meaning of Parkinson's Disease Clinical Scale Scores

Parkinson's disease (PD) is the second most common, neurodegenerative disorder. It is a chronic, disabling, and progressive disease, and no treatment stops its progression. Rating scales are utilized to quantify PD progression and severity. The most conventional scale is the Unified Parkinson's Disease Rating Scale (UPDRS) and its modified version, Movement Disorder Society- (MDS-) UPDRS. An analytical investigation into the use and meaning of these clinical scale scores was conducted to determine if gaps exist in quantifying disease progression and severity. A series of discrepancies were identified including confusion among patients regarding the score meaning and misuse of the scores among clinicians and researchers to define disease progression. The scales are of an ordinal type and hence the resulting scores are ordinal, not providing a quantifiable progression nor severity level, but a categorical value and survey total. The knowledge that the scores are ordinal and the scales are subjective is mentioned in very limited publications, not the focus of these papers, but a brief introduction and a thoroughly researched, analytical investigation into the scales and scores have not been found. Therefore, the continuous misunderstanding and misuse of these scales and resulting scores warrant a comprehensive assessment and evaluation of these scales and scores to identify the gaps.