Hoehn and Yahr scale

The Hoehn and Yahr scale is a commonly used system for describing how the symptoms of Parkinson's disease progress. It was originally published in 1967 in the journal Neurology by Melvin Yahr and Margaret Hoehn and included stages 1 through 5. Since then, a modified Hoehn and Yahr scale was proposed with the addition of stages 1.5 and 2.5 to help describe the intermediate course of the disease.

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

This rating system has been largely supplanted by the Unified Parkinson's Disease Rating Scale, which assesses limitation of daily activities and non-motor symptoms in more detail.

Time between stages

A 2010 study of 695 patients (mean age: 65.2, male: 57.3%) found the median time taken to transit H&Y stages as shown below:

Stage	Median Time to Transit (Months)
1	-
2	20
2.5	62
3	25
4	24
5	26

References

• Hoehn M, Yahr M (1967). "Parkinsonism: onset, progression and mortality.". Neurology 17 (5): 427–42. doi:10.1212/wnl.17.5.427. PMID 6067254.
• Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, Giladi N, Holloway RG, Moore CG, Wenning GK, Yahr MD, Seidl L (2004). "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.". Movement Disorders 19 (9): 1020–1028. doi:10.1002/mds.20213. PMID 15372591.
• Zhao YJ, Wee HL, Chan YH, Seah SH, Au WL, Lau PN, Pica EC, Li SC, Luo N, Tan LC (2010). "Progression of Parkinson's disease as evaluated by Hoehn and Yahr stage transition times.". Mov Disord 25 (6): 710–716. doi:10.1002/mds.22875. PMID 20213822.