ANNEX 3 183
37. Are “off periods unpredictable?
0 = No
1 = Yes
38. Do “off ” periods come on suddenly, within a few seconds?
0 = No
1 = Yes
39. What proportion of the waking day is the patient “off ” on average?
0 = None
1 = 1–25% of day.
2 = 26–50% of day.
3 = 51–75% of day.
4 = 76–100% of day.
C. OTHER COMPLICATIONS
40. Does the patient have anorexia, nausea, or vomiting?
0 = No
1 = Yes
41. Any sleep disturbances, such as insomnia or hypersomnolence?
0 = No
1 = Yes
42. Does the patient have symptomatic orthostasis?
(Record the patients blood pressure, height, and weight on the scoring form)
0 = No
1 = Yes
V. MODIFIED HOEHN AND YAHR STAGING
STAGE 0 = No signs of disease.
STAGE 1 = Unilateral disease.
STAGE 1.5 = Unilateral plus axial involvement.
184 TREMOR
STAGE 2 = Bilateral disease, without impairment of balance.
STAGE 2.5 = Mild bilateral disease, with recovery on pull test.
STAGE 3 = Mild to moderate bilateral disease; some postural instability; physically independent.
STAGE 4 = Severe disability; still able to walk or stand unassisted.
STAGE 5 = Wheelchair bound or bedridden unless aided.
From: Fahn et al. (1987).

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