MDS-NMS

International Parkinson and Movement Disorder Society –

Non-Motor Rating Scale

Authored by:
Kallol Ray Chaudhuri
Pablo Martinez-Martin
Anette Schrag
Daniel Weintraub
Alexandra Rizos
Carmen Rodriguez-Blazquez

Tel +1 (414) 276-2145 555 E. Wells Street, Suite 1100 www.movementdisorders.org

Fax +1 (414) 276-3349 Milwaukee, WI 53202-3823 info@movementdisorders.org

Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved.
MDS Permissions

The International Parkinson and Movement Disorder Society – Non-Motor

Rating Scale (MDS-NMS) is owned and licensed by the International
Parkinson and Movement Disorder Society (MDS). Permission is required to use
the scale and can be obtained by submitting a Permissions Request Form on the
MDS website. For licensing inquiries, please e-mail info@movementdisorders.org.

Unauthorized reproduction, distribution, translation, or sale of any portion of the

MDS-NMS is strictly prohibited. Changes, modifications, and derivative works of
the scale are not permitted without the express authorization of MDS. Including
but not limited to the following, the MDS-NMS may not be incorporated into clinical
trials, training materials, certification programs, software programs, electronic
platforms, electronic medical records, databases, or devices except by permission
of MDS.

Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved.
 International Parkinson and Movement Disorder Society –
Non-Motor Rating Scale (MDS-NMS)
RATER-ADMINISTERED VERSION
Rate symptoms over past 4 weeks
Patient Name or Identifier: ______________________________________
Date: ______________________________________

Respondent: □ Patient □ Informant/Caregiver □ Patient and Informant

Patient’s motor state: □ On □ Off
SCORING
Average Frequency / Duration: (percentages denote days per week or hours per waking day)
0: Never
1: Rarely (≤ 10% of time)
2: Sometimes (11-25% of time)
3: Frequently (26-50% of time)
4: Majority of time (≥ 51% of time)
Average Severity:
0: Not present (only if frequency = 0)
1: Minimal (no distress or disturbance to patient or caregiver)
2: Mild (minor distress or disturbance to patient or caregiver)
3: Moderate (considerable distress or disturbance to patient or caregiver)
4: Severe (major distress or disturbance to patient or caregiver)
Calculations:
Item Total = Frequency multiplied by severity
Subscale Total = Sum of all Item totals for that Subscale
MDS-NMS Total Score = Sum of totals for Subscales A-M

For each question use the following introduction:

“How often have you...” or “How often has the patient...”

If the answer to the question is “Never”, rate frequency/duration as “0”, rate severity also as “0” and move
on to the next question.

If the answer to the question is not “Never”, then ask:

“When you have had… / When the patient has had… [the symptom], how bad has it been on
average?”

When answering questions about an “increase” or “decrease”/“reduction” in symptoms, use as your

comparison point your/the patient’s experiences on average as an adult prior to having Parkinson’s
disease.

Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved. | Version 1.0 1
 International Parkinson and Movement Disorder Society –
Non-Motor Rating Scale (MDS-NMS)
RATER-ADMINISTERED VERSION
Rate symptoms over past 4 weeks
Frequency Severity Frequency
(0-4) (0-4) x severity
A. Depression:
1. Felt sad or depressed? ....................................................................
2. Had difficulty experiencing pleasure? ...............................................
3. Felt hopeless? .................................................................................
4. Had negative thoughts about yourself? ............................................
5. Felt that life is not worth living? ........................................................
Subscale A Total

B. Anxiety:
1. Felt worried? ....................................................................................
2. Felt nervous? ...................................................................................
3. Had panic or anxiety attacks? ..........................................................
4. Been worried about being in public or in social situations?...............
Subscale B Total

C. Apathy:
1. Had a reduced motivation to start day-to-day activities? ..................
2. Had a reduced interest in talking to people? ....................................
3. Had a reduction in experiencing emotions?......................................
Subscale C Total
D. Psychosis:
1. Sensed things or people in margins of your visual field?
(passage or presence phenomena) ..................................................
2. Visually misinterpreted an actual object? (illusions) .........................
3. Seen, heard, felt, tasted, or smelled things that other people did
not? (hallucinations) .........................................................................
4. Believed things to be true that others did not?
(e.g., delusions of persecution, jealousy, or misidentification) ..........
Subscale D Total
E. Impulse Control and Related Disorders:
1. Had an increase in gambling, sexual, buying, or eating behaviors?
2. Had an increase in other behaviors (e.g., internet use, hobbies,
artistic activities, writing, hoarding)? .................................................
3. Repeatedly handled objects without any purpose? (punding) ..........
4. Routinely taken more anti-parkinsonian medications than
prescribed? (dopamine dysregulation syndrome) .............................
Subscale E Total
Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved. | Version 1.0 2
 International Parkinson and Movement Disorder Society –
Non-Motor Rating Scale (MDS-NMS)
RATER-ADMINISTERED VERSION
Rate symptoms over past 4 weeks

Frequency Severity Frequency

(0-4) (0-4) x severity
F. Cognition:
1. Had difficulty remembering things? ..................................................
2. Had difficulty learning new things? ...................................................
3. Had difficulty keeping focus or paying attention? .............................
4. Had difficulty finding words or expressing ideas? .............................
5. Had difficulty planning or carrying out complex tasks, not due to
motor problems? (executive abilities) ...............................................
6. Had difficulty judging the position of things? (visuospatial
abilities) ...........................................................................................
Subscale F Total

G. Orthostatic Hypotension:
1. Felt lightheaded or fainted when changing position? ........................
2. Had dizziness or weakness upon standing?.....................................
Subscale G Total

H. Urinary:
1. Had an urgent need to empty bladder? (urinary urgency) ................
2. Had to empty bladder more than every 2 hours?
(urinary frequency) ...........................................................................
3. Had to empty bladder more than twice overnight? (nocturia) ...........
Subscale H Total

I. Sexual:
1. Had decreased sexual drive or interest in sex? ................................
2. Had difficulty with sexual arousal (e.g., erectile dysfunction or
vaginal dryness) or sexual performance not related to motor
problems (e.g., not related to Parkinson’s rigidity)? .........................
Subscale I Total

J. Gastrointestinal:
1. Had any drooling of saliva? ..............................................................
2. Had difficulty swallowing? ................................................................
3. Had nausea or felt sick in the stomach?...........................................
4. Had constipation? (defined as < 3 bowel movements/week) ............
Subscale J Total

Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved. | Version 1.0 3
 International Parkinson and Movement Disorder Society –
Non-Motor Rating Scale (MDS-NMS)
RATER-ADMINISTERED VERSION
Rate symptoms over past 4 weeks

Frequency Severity Frequency

(0-4) (0-4) x severity
K. Sleep and Wakefulness:
1. Had difficulty falling asleep or staying asleep? (insomnia)................
2. Acted out dreams while asleep, such as shouting, flailing arms,
punching, or running movements? (REM sleep behavior) ................
3. Dozed off or fallen asleep unintentionally during waking hours?
(e.g., during conversation, at mealtimes, or while driving, watching
television; excessive daytime sleepiness) ........................................
4. Had an irresistible urge to move legs or arms when sitting or
lying down which improved with movement? (restlessness) .............
5. Had any involuntary jerky movements in arms or legs during sleep
or while resting? (periodic limb movements).....................................
6. Woken at night due to snoring, gasping, or difficulty with
breathing? ........................................................................................
Subscale K Total

L. Pain:
1. Had muscle, joint, or back pain? ......................................................
2. Had a deep or dull aching pain within the body? ..............................
3. Had pain due to abnormal twisting movements of arms or legs
or body, often present in the early morning period? (dystonia) .........
4. Had other types of pain? (e.g., nocturnal pain, orofacial pain) ..........
Subscale L Total
M. Other:
1. Had an unintentional weight loss?
(rate frequency as either not present (0) or present (4);
for severity rate 0 (only if frequency = 0), 1 (minimal), 2 (mild),
3 (moderate), or 4 (severe)) ............................................................
2. Had a decrease in sense of smell? (impaired olfaction)
(rate frequency as either not present (0) or present (4);
for severity rate 0 (only if frequency = 0), 1 (minimal), 2 (mild),
3 (moderate), or 4 (severe)) ............................................................
3. Felt excessively physically tired? (physical fatigue) ..........................
4. Felt excessively mentally tired? (mental fatigue) ..............................
5. Had excessive sweating not related to temperature? .......................
Subscale M Total

MDS-NMS TOTAL SCORE

Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved. | Version 1.0 4
 International Parkinson and Movement Disorder Society –
Non-Motor Rating Scale (MDS-NMS)
RATER-ADMINISTERED VERSION
Rate symptoms over past 4 weeks
MDS-NMS Non-Motor Fluctuations (NMF) Subscale
Do you / Does the patient experience changes in non-motor symptoms (as listed below) in relation to the
timing of anti-parkinsonian medications (i.e., symptoms occurring or worsening during “Off” period)?

□ Yes □ No

If no, MDS-NMS NMF Total Score (below) = 0

If yes, please complete the following section:

SCORING
Typical degree of change from “On” to “Off” period:
0: No change
1: Minimal
2: Small
3: Medium
4: Large
Subscore “Change” = Sum of all “Degree of change” items
MDS-NMS NMF Total Score = Subscore “Change” multiplied by Subscore “Time”
”off”
Degree of change
(0-4)

1. Depression (as listed in Subscale A) ..................................................................................

2. Anxiety (as listed in Subscale B) ........................................................................................
3. Thinking or cognitive abilities (as listed in Subscale F) .......................................................
4. Bladder symptoms (as listed Subscale H) ..........................................................................
5. Restlessness (as listed in Subscale K, item 4) ...................................................................
6. Pain (as listed in Subscale L) .............................................................................................
7. Fatigue (as listed in Subscale M, items 3 and 4) ................................................................
8. Excessive sweating (as listed in Subscale M, item 5) .........................................................

Time spent in non-motor “Off” state: MDS-NMS NMF

Subscore “Change”
1: Rarely (≤ 10% of waking day)
2: Sometimes (11-25% of waking day) MDS-NMS NMF
Subscore “Time”
3: Frequently (26-50% of waking day)
4: Majority of time (≥ 51% of waking day)

MDS-NMS NMF Total Score

(Subscore “Change” x “Time”)

Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved. | Version 1.0 5
Patient Name/Identifier: ______________________________ Date: __________________________

MDS-NMS Score Sheet

RATER-ADMINISTERED VERSION
Item Total = Frequency multiplied by Severity
Subscale Total = Sum of all Item Totals for that Subscale
MDS-NMS Total Score = Sum of Totals for Subscales A-M

Respondent: □ Patient □ Informant/Caregiver □ Patient and Informant

Patient’s motor state: □ On □ Off
A. Depression Frequency Severity Total
1. Sad or depressed
2. Experiencing pleasure
3. Hopelessness
4. Negative thoughts
5. Life not worth living
Depression Subscale Total

B. Anxiety Frequency Severity Total

1. Worried
2. Nervous
3. Panic or anxiety attacks
4. Social phobia
Anxiety Subscale Total

C. Apathy Frequency Severity Total

1. Interest activities
2. Interest talking
3. Emotions
Apathy Subscale Total

D. Psychosis Frequency Severity Total

1. Passage or presence phenomena
2. Illusions
3. Hallucinations
4. Delusions
Psychosis Subscale Total

E. Impulse Control and Related Disorders Frequency Severity Total

1. Impulse control disorders
2. Other compulsive behaviors
3. Punding
4. Dopamine dysregulation syndrome
Impulse Control and Related Disorders Subscale Total
Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved. | Version 1.0 6
Patient Name/Identifier: ______________________________ Date: __________________________

F. Cognition Frequency Severity Total

1. Remembering
2. Learning new information
3. Focus or attention
4. Find words or express ideas
5. Executive abilities
6. Visuospatial abilities
Cognition Subscale Total

G. Orthostatic Hypotension Frequency Severity Total

1. Lightheaded or fainted
2. Dizziness or weakness
Orthostatic Hypotension Subscale Total

H. Urinary Frequency Severity Total

1. Urinary urgency
2. Urinary frequency
3. Nocturia
Urinary Subscale Total

I. Sexual Frequency Severity Total

1. Sex drive or interest
2. Sexual arousal or performance
Sexual Subscale Total

J. Gastrointestinal Frequency Severity Total

1. Drooling
2. Swallowing
3. Nausea or sick in stomach
4. Constipation
Gastrointestinal Subscale Total

K. Sleep and Wakefulness Frequency Severity Total

1. Insomnia
2. REM sleep behavior
3. Dozing off
4. Restlessness
5. Periodic limb movements
6. Snoring or difficulty breathing
Sleep and Wakefulness Subscale Total

Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved. | Version 1.0 7
Patient Name/Identifier: ______________________________ Date: __________________________

L. Pain Frequency Severity Total

1. Muscle, joint, back pain
2. Deep or dull pain
3. Dystonia
4. Other pain
Pain Subscale Total

M. Other Frequency Severity Total

1. Weight loss
2. Decreased smell
3. Physical fatigue
4. Mental fatigue
5. Excessive sweating
Other Subscale Total

MDS-NMS TOTAL SCORE

MDS-NMS Score Sheet – Non Motor Fluctuations

Subscore “Change” = Sum of all “degree of change” items
Subscore “Time” = Time spent in non-motor “Off” state
MDS-NMS NMF Total Score = Subscore “Change” multiplied by Subscore “Time”

Typical degree of
NON-MOTOR FLUCTUATIONS change from “On” to
(optional) “Off” period
1. Depression
2. Anxiety
3. Thinking or cognitive abilities
4. Bladder symptoms
5. Restlessness
6. Pain
7. Fatigue
8. Excessive sweating
Subscore “Change”

Subscore “Time”

MDS-NMS NON-MOTOR FLUCTUATIONS TOTAL SCORE

Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved. | Version 1.0 8
 International Parkinson and Movement Disorder Society –
Non-Motor Rating Scale (MDS-NMS)

Glossary of Terms

A. Depression: a mood disorder characterized by sustained change in emotions (sadness, decreased

interest or pleasure), cognition (negative thoughts about life or self, such as hopelessness,
helplessness, indecisiveness, or death or suicide ideation) or behavior (isolative, withdrawn, sleep
disturbances, appetite disturbances)

B. Anxiety: an affective disorder characterized by sustained excessive worrying which can be (1)
generalized and include symptoms such as restlessness, being easily fatigued, mind going blank or
trouble concentrating, irritability, and muscle tension; (2) specific anxiety or panic attacks; (3) fear of
being in public (agoraphobia); or (4) fear of being in social situations (social phobia)
Anxiety or panic attack: an abrupt surge of intense fear or intense discomfort, can include
shortness of breath, heart beating fast, upset stomach, sweating, dizziness or faintness, sensation
of chill or heat, or sense something bad is going to happen or even a sense of dying

C. Apathy: a disorder characterized by decreased motor activity (less initiation of motor activity not due
to parkinsonism), emotional expression (less emotional engagement separate from decreased facial
expression due to parkinsonism), or speech (less likely to initiate or engage in conversation)

D. Psychosis: a disorder characterized by changes in perception (passage or presence phenomena,

illusions, or hallucinations) or thought (delusions)
Passage phenomenon: visual sensation of something moving in periphery of visual field
Presence phenomenon: visual sensation of person being in periphery of visual field
Illusions: visual misinterpretation of an actual object
Hallucinations: a sensory (visual, auditory, taste, smell, or feeling) experience that is not real or
experienced by other people
Delusions: a belief that something is true for which there is no objective evidence and which
other persons do not hold true

E. Impulse control disorders: a failure to resist an impulse or drive that leads to repeated
engagement in activities that become harmful to self or others; compared with pre-PD behavior
Hoarding: the needless collection of objects and an inability to get rid of them
Punding: the needless or purposeless repetition of a simple motor activity
Dopamine dysregulation syndrome: taking an excess (beyond what is prescribed) of
Parkinson’s disease medications for their motor or psychological effects, often with significant
mood changes during “on” (irritability, hypomania) or “off” (dysphoria) states

F. Cognition: the activities of thinking, understanding, learning, and remembering

Attention: concentrating on one part of the environment while ignoring other things
Executive abilities: cognitive processes involved in maintaining multiple pieces of information in
the mind at the same time, reasoning, task flexibility, problem solving, and task planning and
execution
Visuospatial abilities: ability relating to visual perception of spatial relationships among objects

Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved. | Version 1.0 9
 International Parkinson and Movement Disorder Society –
Non-Motor Rating Scale (MDS-NMS)

G. Orthostatic hypotension: a drop in blood pressure severe enough to cause symptoms when
changing from sitting to standing position or from lying to sitting position

H. Urinary
Nocturia: excessive urination at night, defined as more than 2 times overnight

I. Sexual
Erectile dysfunction: inability of a man to maintain an erection sufficient for satisfying sexual
activity

J. Gastrointestinal: relating to the stomach and intestines

Saliva: watery liquid secreted into the mouth by glands, providing lubrication for chewing and
swallowing, and aiding digestion
Swallowing: difficulty swallowing including liquids and solids, as well as choking while
swallowing
Nausea: a feeling of sickness with a tendency to vomit
Constipation: infrequent bowel movements (usually less than three bowel movements per week)
or difficult passage of stools

K. Sleep and wakefulness

Insomnia: difficultly falling asleep or staying asleep
Rapid eye movement (REM) sleep: a stage in the normal sleep cycle during which dreams occur
and the body undergoes marked changes including rapid eye movement, loss of reflexes, and
increased pulse rate and brain activity

L. Pain
Dystonia: a state of abnormal muscle tone resulting in muscular spasm and abnormal posture
Nocturnal pain: pain overnight
Orofacial pain: pain which is felt in the mouth, jaws, or face

M. Other
Olfaction: the action or capacity of smelling
Fatigue (physical): state of excessive physical weariness or exhaustion (after physical exertion),
different from sleepiness
Fatigue (mental): state of excessive mental weariness or exhaustion, different from sleepiness

Copyright © 2019 International Parkinson and Movement Disorder Society. All rights reserved. | Version 1.0 10