Hoehn and Yahr Scale

Authors

Affiliations

Nathaniel Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

• The Hoehn & Yahr (H&Y) system for grading severity of Parkinson’s disease (PD) symptoms uses a scale of 1 to 5 to evaluate the extent of patients’ clinical disability
• HY scale has remained the most commonly and most widely used scale to describe severity of PD worldwide¹.

Scoring

Table 1

Stage	Hoehn and Yahr Scale	Modified Hoehn and Yahr Scale
1	Unilateral involvement only usually with minimal or no functional disability	Unilateral involvement only
1.5	-	Unilateral and axial involvement
2	Bilateral or midline involvement without impairment of balance	Bilateral involvement without impairment of balance
2.5	-	Mild bilateral disease with recovery on pull test
3	Bilateral disease: mild to moderate disability with impaired postural reflexes; physically independent	Mild to moderate bilateral disease; some postural instability; physically independent
4	Severely disabling disease; still able to walk or stand unassisted	Severe disability; still able to walk or stand unassisted
5	Confinement to bed or wheelchair unless aided	Wheelchair bound or bedridden unless aided

Interpretation

• Higher H&Y scores have been linked with a more rapid cognitive decline in PD patients².
• Generally, a higher H&Y scores correlates with poorer quality of life².

Stages 1-3

• Considered “minimally disabled”
• Still able to lead independent lives

Stage 4-5

• Considered “severely disabled”
• Motor symptom severity has been associated with various neurocognitive issues:
  • Dementia
  • Depression
  • Hallucinations

Strengths

see¹

Considerations

• Dual tasking can

References

1.

Goetz CG, Poewe W, Rascol O, et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: Status and recommendations. Movement Disorders: Official Journal of the Movement Disorder Society. 2004;19(9):1020-1028. doi:10.1002/mds.20213

2.

Modestino EJ, Reinhofer A, Blum K, Amenechi C, O’Toole P. Hoehn and Yahr staging of Parkinson’s disease in relation to neuropsychological measures. Frontiers in Bioscience (Landmark Edition). 2018;23(7):1370-1379. doi:10.2741/4649