Data Dictionary for mp2cevfu

Number of Blaise fields: 619

Seq # Var Question Data Type/Coding
1 projid MAP 2001 FOLLOW-UP Clinical Evaluation (Version: 12/29/2020) Enter project ID number. String[8]
2 visit Enter curent visit code from face sheet: CODE F/U Year CODE F/U Year CODE F/U Year CODE F/U Year 00 = Baseline 08 = 8th F/U 16 = 16th F/U 24 = 24th F/U 01 = 1st F/U 09 = 9th F/U 17 = 17th F/U 25 = 25th F/U 02 = 2nd F/U 10 = 10th F/U 18 = 18th F/U 26 = 26th F/U 03 = 3rd F/U 11 = 11th F/U 19 = 19th F/U 27 = 27th F/U 04 = 4th F/U 12 = 12th F/U 20 = 20th F/U 28 = 28th F/U 05 = 5th F/U 13 = 13th F/U 21 = 21th F/U 29 = 29th F/U 06 = 6th F/U 14 = 14th F/U 22 = 22th F/U 30 = 30th F/U 07 = 7th F/U 15 = 15th F/U 23 = 23th F/U String[2]
3 baseyear Enter year of baseline from face sheet: 1993 .. 2025
4 formno Form Number String[8]
5 version Version Number String[4]
6 autodate Automatic Date. Date type
7 autotime Automatic Time. TimeType
8 autolog Automatic Logged Date. Date type
9 intid INTERVIEWER ID 100 .. 997
10 compid Laptop ID String[20]
11 dateint Date of interview Date type
12 datlas Date of last clinical evaluation Date type
13 sex Subject's sex. 1= Male 2= Female
14 phone Was this interview completed in person or over the telephone? 1= In-person 2= Telephone
15 autotm [COMPUTER CLOCK TIME] String[8]
16 q1drg Now I would like to ask you about medicines. 1. During the past two weeks, HAVE YOU TAKEN ANY MEDICINE PRESCRIBED by a doctor? 1= Yes 2= No
17 q2drg 2. Now, about supplements not usually prescribed by a doctor such as vitamin preparations including multivitamins, vitamin C, vitamin A, vitamin D, or vitamin E . . . During the past two weeks have you taken any of these or any other vitamin preparations? 1= Yes 2= No
18 q3drg 3. We are also interested in other medicines or supplements not prescribed by a doctor such as aspirin, Tylenol, Bufferin, Anacin, headache pills or pain killers, laxatives or bowel medicines, cold medicines, cough medicines, sleep medicines, antacids or stomach medicines, ointments or salves . . . During the past two weeks have you taken any of these or any other medicines from the drug store? 1= Yes 2= No
19 q4drg 4. May I please see all these medicines for the past two weeks? [INTERVIEWER RECORD ALL MEDICINES TAKEN WITHIN THE PAST 2 WEEKS WHETHER AVAILABLE FOR INSPECTION OR NOT] [ENTER TOTAL NUMBER OF MEDICINES TO BE RECORDED] 0 .. 50
20 name00 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
21 stren00 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
22 drgnm00 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
23 seen00 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
24 dosage00 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
25 recd00 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
26 name01 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
27 stren01 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
28 drgnm01 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
29 seen01 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
30 dosage01 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
31 recd01 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
32 name02 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
33 stren02 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
34 drgnm02 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
35 seen02 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
36 dosage02 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
37 recd02 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
38 name03 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
39 stren03 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
40 drgnm03 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
41 seen03 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
42 dosage03 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
43 recd03 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
44 name04 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
45 stren04 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
46 drgnm04 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
47 seen04 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
48 dosage04 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
49 recd04 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
50 name05 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
51 stren05 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
52 drgnm05 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
53 seen05 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
54 dosage05 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
55 recd05 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
56 name06 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
57 stren06 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
58 drgnm06 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
59 seen06 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
60 dosage06 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
61 recd06 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
62 name07 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
63 stren07 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
64 drgnm07 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
65 seen07 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
66 dosage07 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
67 recd07 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
68 name08 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
69 stren08 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
70 drgnm08 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
71 seen08 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
72 dosage08 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
73 recd08 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
74 name09 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
75 stren09 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
76 drgnm09 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
77 seen09 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
78 dosage09 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
79 recd09 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
80 name10 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
81 stren10 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
82 drgnm10 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
83 seen10 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
84 dosage10 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
85 recd10 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
86 name11 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
87 stren11 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
88 drgnm11 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
89 seen11 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
90 dosage11 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
91 recd11 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
92 name12 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
93 stren12 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
94 drgnm12 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
95 seen12 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
96 dosage12 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
97 recd12 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
98 name13 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
99 stren13 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
100 drgnm13 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
101 seen13 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
102 dosage13 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
103 recd13 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
104 name14 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
105 stren14 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
106 drgnm14 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
107 seen14 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
108 dosage14 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
109 recd14 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
110 name15 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
111 stren15 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
112 drgnm15 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
113 seen15 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
114 dosage15 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
115 recd15 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
116 name16 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
117 stren16 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
118 drgnm16 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
119 seen16 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
120 dosage16 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
121 recd16 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
122 name17 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
123 stren17 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
124 drgnm17 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
125 seen17 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
126 dosage17 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
127 recd17 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
128 name18 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
129 stren18 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
130 drgnm18 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
131 seen18 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
132 dosage18 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
133 recd18 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
134 name19 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
135 stren19 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
136 drgnm19 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
137 seen19 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
138 dosage19 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
139 recd19 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
140 name20 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
141 stren20 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
142 drgnm20 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
143 seen20 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
144 dosage20 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
145 recd20 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
146 name21 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
147 stren21 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
148 drgnm21 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
149 seen21 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
150 dosage21 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
151 recd21 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
152 name22 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
153 stren22 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
154 drgnm22 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
155 seen22 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
156 dosage22 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
157 recd22 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
158 name23 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
159 stren23 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
160 drgnm23 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
161 seen23 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
162 dosage23 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
163 recd23 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
164 name24 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
165 stren24 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
166 drgnm24 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
167 seen24 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
168 dosage24 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
169 recd24 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
170 name25 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
171 stren25 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
172 drgnm25 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
173 seen25 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
174 dosage25 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
175 recd25 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
176 name26 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
177 stren26 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
178 drgnm26 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
179 seen26 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
180 dosage26 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
181 recd26 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
182 name27 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
183 stren27 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
184 drgnm27 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
185 seen27 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
186 dosage27 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
187 recd27 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
188 name28 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
189 stren28 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
190 drgnm28 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
191 seen28 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
192 dosage28 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
193 recd28 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
194 name29 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
195 stren29 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
196 drgnm29 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
197 seen29 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
198 dosage29 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
199 recd29 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
200 name30 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
201 stren30 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
202 drgnm30 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
203 seen30 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
204 dosage30 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
205 recd30 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
206 name31 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
207 stren31 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
208 drgnm31 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
209 seen31 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
210 dosage31 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
211 recd31 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
212 name32 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
213 stren32 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
214 drgnm32 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
215 seen32 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
216 dosage32 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
217 recd32 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
218 name33 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
219 stren33 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
220 drgnm33 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
221 seen33 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
222 dosage33 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
223 recd33 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
224 name34 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
225 stren34 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
226 drgnm34 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
227 seen34 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
228 dosage34 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
229 recd34 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
230 name35 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
231 stren35 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
232 drgnm35 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
233 seen35 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
234 dosage35 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
235 recd35 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
236 name36 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
237 stren36 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
238 drgnm36 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
239 seen36 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
240 dosage36 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
241 recd36 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
242 name37 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
243 stren37 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
244 drgnm37 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
245 seen37 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
246 dosage37 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
247 recd37 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
248 name38 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
249 stren38 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
250 drgnm38 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
251 seen38 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
252 dosage38 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
253 recd38 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
254 name39 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
255 stren39 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
256 drgnm39 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
257 seen39 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
258 dosage39 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
259 recd39 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
260 name40 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
261 stren40 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
262 drgnm40 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
263 seen40 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
264 dosage40 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
265 recd40 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
266 name41 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
267 stren41 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
268 drgnm41 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
269 seen41 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
270 dosage41 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
271 recd41 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
272 name42 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
273 stren42 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
274 drgnm42 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
275 seen42 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
276 dosage42 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
277 recd42 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
278 name43 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
279 stren43 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
280 drgnm43 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
281 seen43 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
282 dosage43 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
283 recd43 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
284 name44 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
285 stren44 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
286 drgnm44 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
287 seen44 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
288 dosage44 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
289 recd44 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
290 name45 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
291 stren45 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
292 drgnm45 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
293 seen45 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
294 dosage45 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
295 recd45 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
296 name46 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
297 stren46 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
298 drgnm46 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
299 seen46 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
300 dosage46 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
301 recd46 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
302 name47 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
303 stren47 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
304 drgnm47 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
305 seen47 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
306 dosage47 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
307 recd47 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
308 name48 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
309 stren48 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
310 drgnm48 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
311 seen48 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
312 dosage48 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
313 recd48 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
314 name49 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
315 stren49 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
316 drgnm49 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
317 seen49 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
318 dosage49 d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] 1 .. 66
319 recd49 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
320 strokefu MEDICAL HISTORY First I would like to ask you a few questions about specific medical conditions such as stroke and Parkinson's disease. STROKE 1. Since your evaluation on [last interview date], have you been told by a doctor, nurse or therapist that you had a STROKE, TRANSIENT ISCHEMIC ATTACK (TIA) or BRAIN HEMORRHAGE? 1= Yes 2= Suspect or possible 3= No
321 faint0fu At the time of this (last) event, did you you have . . . a. Fainting, blackout or loss of consciousness? 1= Yes 2= Suspect 3= No
322 dizzy0fu b. Dizzyness or lightheadedness? 1= Yes 2= Suspect 3= No
323 memor0fu c. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
324 speec0fu d. Language or speech change? 1= Yes 2= Suspect 3= No
325 visio0fu e. Loss of vision? 1= No 2= right only 3= left only 4= both
326 face0fu f. Weakness or paralysis of your face? 1= No 2= right only 3= left only 4= both
327 weakl0fu g. Weakness or paralysis of your arms or legs? 1= No 2= right only 3= left only 4= both
328 limse0fu h. Loss or change of sensation in your arms or legs? 1= No 2= right only 3= left only 4= both
329 symps0fu i. Specify any other signs or symptoms associated with this (last) event? String[40]
330 samet0fu j. Did the stroke occur around the same time as a SURGICAL OPERATION, HEART ATTACK, BREATHING DIFFICULTY, or ANOTHER SERIOUS MEDICAL PROBLEM? 1= Yes 2= Suspect 3= No
331 sames0fu Specify: String[60]
332 inhospfu 2. Since your evaluation on [last interview date], have you been HOSPITALIZED OVERNIGHT or longer because of a STROKE, a TIA or a BRAIN HEMORRHAGE? 1= Yes 2= Suspect 3= No
333 promp1fu 2a. Was this the same event we just spoke about? 1= Yes 2= No
334 hospnafu 2b. What was the name of the hospital? String[30]
335 faint1fu At the time of this (last) event, did you you have . . . a. Fainting, blackout or loss of consciousness? 1= Yes 2= Suspect 3= No
336 dizzy1fu b. Dizzyness or lightheadedness? 1= Yes 2= Suspect 3= No
337 memor1fu c. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
338 speec1fu d. Language or speech change? 1= Yes 2= Suspect 3= No
339 visio1fu e. Loss of vision? 1= No 2= right only 3= left only 4= both
340 face1fu f. Weakness or paralysis of your face? 1= No 2= right only 3= left only 4= both
341 weakl1fu g. Weakness or paralysis of your arms or legs? 1= No 2= right only 3= left only 4= both
342 limse1fu h. Loss or change of sensation in your arms or legs? 1= No 2= right only 3= left only 4= both
343 symps1fu i. Specify any other signs or symptoms associated with this (last) event? String[40]
344 samet1fu j. Did the stroke occur around the same time as a SURGICAL OPERATION, HEART ATTACK, BREATHING DIFFICULTY, or ANOTHER SERIOUS MEDICAL PROBLEM? 1= Yes 2= Suspect 3= No
345 sames1fu Specify: String[60]
346 stroksfu 3. Since [last interview date], have you had a CT, MRI or other type of brain scan because of a STROKE, a TIA or a BRAIN HEMORRHAGE? 1= Yes 2= Suspect 3= No
347 promp2fu 3a. Was this for ^event we just spoke about? 1= Yes 2= No
348 scanlofu 3b. What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? String[30]
349 faint2fu At the time of this (last) event, did you you have . . . a. Fainting, blackout or loss of consciousness? 1= Yes 2= Suspect 3= No
350 dizzy2fu b. Dizzyness or lightheadedness? 1= Yes 2= Suspect 3= No
351 memor2fu c. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
352 speec2fu d. Language or speech change? 1= Yes 2= Suspect 3= No
353 visio2fu e. Loss of vision? 1= No 2= right only 3= left only 4= both
354 face2fu f. Weakness or paralysis of your face? 1= No 2= right only 3= left only 4= both
355 weakl2fu g. Weakness or paralysis of your arms or legs? 1= No 2= right only 3= left only 4= both
356 limse2fu h. Loss or change of sensation in your arms or legs? 1= No 2= right only 3= left only 4= both
357 symps2fu i. Specify any other signs or symptoms associated with this (last) event? String[40]
358 samet2fu j. Did the stroke occur around the same time as a SURGICAL OPERATION, HEART ATTACK, BREATHING DIFFICULTY, or ANOTHER SERIOUS MEDICAL PROBLEM? 1= Yes 2= Suspect 3= No
359 sames2fu Specify: String[60]
360 multipfu 4. Since your last evaluation on [last interview date], did you have only ONE STROKE, TIA or BRAIN HEMORRHAGE, or more than one? 1= Only one 2= More than one
361 leftspfu 5. Specify leftover troubles from your stroke(s)? String[60]
362 everscfu 6. Since [last interview date], have you had a CT, MRI or other type of brain scan? 1= Yes 2= Suspect 3= No
363 reasonfu 6c. Reason String[60]
364 escanlfu 6d. What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? String[30]
365 parksfu 1. Since [last interview date], have you been told by a doctor, nurse or therapist that you had PARKINSONISM or PARKINSON'S DISEASE? 1= Yes 2= Suspect or possible 3= No
366 gaitfu With the parkinsonism, did you have . . . 2. Shuffling or unsteady gait, or loss of balance? 1= Yes 2= Suspect 3= No
367 writinfu 3. A change in your handwriting? 1= Yes 2= Suspect 3= No
368 stifffu 4. Stiffness or rigidity of your arms or legs? 1= No 2= right only 3= left only 4= both
369 slowmofu 5. Slowness of movement of your arms, hands or legs? 1= No 2= right only 3= left only 4= both
370 tremorfu 6. Tremor of your hands or feet? 1= No 2= right only 3= left only 4= both
371 medicafu 7. Are you currently taking any medication for your parkinsonism or Parkinson's disease (some examples are Sinemet, Symmetrel, Parlodel, Bromocriptine, etc.)? 1= Yes 2= Suspect or possible 3= No
372 medspefu 7a. Specify String[30]
373 histadfu Since your last evaluation on [last interview date], have you been told by a doctor, nurse, or therapist that you had dementia, senility, or Alzheimer's disease? 1= Yes 2= Susupect 3= No
374 respqs Will MEP/MIP data be entered directly into Blaise form? 1= Yes 2= No
375 expir1 EXPIRATORY RESPIRATORY PRESSURE TESTING [Use the Expiratory Respiratory Pressure Valve for the Micro MPM.] [Reset to 0. Enter 995.5 for tried, but unable.] MEP trial 1 ________ cm H20 1.0 .. 995.5
376 expir2 [Reset to 0. Enter 995.5 for tried, but unable.] MEP trial 2 ________ cm H20 1.0 .. 995.5
377 inspir1 INSPIRATORY RESPIRATORY PRESSURE TESTING [Use the Inspiratory Respiratory Pressure Valve for the Micro MPM.] [Reset to 0. Enter 995.5 for tried, but unable.] MIP trial 1 ________ cm H20 1.0 .. 995.5
378 inspir2 [Reset to 0. Enter 995.5 for tried, but unable.] MIP trial 2 ________ cm H20 1.0 .. 995.5
379 mepmipcm MEP/MIP Enter any comments. [Press enter to continue if none.] String[250]
380 spiroqs Will spirometry data be entered directly into Blaise form? 1= Yes 2= No
381 fev11 RESET Spirometry device FEV1 Trial 1 [Enter 95.5 for tried but unable.] _____ liters 0.00 .. 95.50
382 pvc1 PVC Trial 1 _____ liters 0.00 .. 10.00
383 fer1 FER Trial 1 _____ percent 0 .. 100
384 pef1 PEF Trial 1 _____ liters/minute [If greater than 999, enter 999.] 0 .. 999
385 fev12 RESET Spirometry device FEV1 Trial 2 [Enter 95.5 for tried but unable.] _____ liters 0.00 .. 95.50
386 pvc2 PVC Trial 2 _____ liters 0.00 .. 10.00
387 fer2 FER Trial 2 _____ percent 0 .. 100
388 pef2 PEF Trial 2 _____ liters/minute [If greater than 999, enter 999.] 0 .. 999
389 spcom Spirometry Enter any comment. [Press enter to continue if none.] String[250]
390 q8atap FINGER TAPPING [DEPRESS BUTTON UNTIL '--' APPEARS.] 1. Right index finger. 'I want to see how quickly you can tap this key. When I tell you to begin, tap this key as quickly as you can until I tell you to stop.' Record first trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 1 .. 97
391 q8ana Specify reason. String[40]
392 q8btap FINGER TAPPING [RESET TAPPER] Left index finger. Record first trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 1 .. 97
393 q8bna Specify reason. String[40]
394 q8ctap FINGER TAPPING [RESET TAPPER] Right index finger. Record second trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 1 .. 97
395 q8cna Specify reason. String[40]
396 q8dtap FINGER TAPPING [RESET TAPPER] Left index finger. Record second trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 1 .. 97
397 q8dna Specify reason. String[40]
398 rhand1 HAND DYNAMOMETRY [SET RED NEEDLE TO 0.] 'I want to see how strongly you can squeeze this handle. When I say go, squeeze the handle as hard as you can until I tell you to stop.' Right Hand Trial 1 [RECORD IN POUNDS.] 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 777
399 rhand1na Specify reason. String[40]
400 lhand1 HAND DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 1 [RECORED IN POUNDS]. 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 777
401 lhand1na Specify reason. String[40]
402 rhand2 HAND DYNAMOMETRY [RESET NEEDLE TO 0.] Right Hand Trial 2 [RECORD IN POUNDS]. 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 777
403 rhand2na Specify reason. String[40]
404 lhand2 HAND DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 2 [RECORD IN POUNDS]. 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 777
405 lhand2na Specify reason. String[40]
406 rthand1 PINCH DYNAMOMETRY [SET RED NEEDLE TO 0.] 'I want to see how strongly you can pinch this plate. When I say go, squeeze the plate as hard as you can until I tell you to stop.' Right Hand Trial 1 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 77
407 rthand1n Specify reason. String[40]
408 lthand1 PINCH DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 1 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 77
409 lthand1n Specify reason. String[40]
410 rthand2 PINCH DYNAMOMETRY [RESET NEEDLE TO 0.] Right Hand Trial 2 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 77
411 rthand2n Specify reason. String[40]
412 lthand2 PINCH DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 2 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] 0 .. 77
413 lthand2n Specify reason. String[40]
414 nasorest NEUROLOGICAL EXAMINATION The neurologic examination should begin with both the subject and examiner comfortably seated facing one another. Right and left are always referenced to the subject. FACIAL STRENGTH [EXAMINER: Observe facial symmetry at rest and with activation of facial muscle groups. Ask subject to raise eyebrows, close eyes, smile.] 1. Nasolabial fold at rest and or action 1= Symmetric 2= Right flatter than left 3= Left flatter than right 7= Unable to test
415 fissures 2. Palpebral fissures 1= Symmetric 2= Right wider than left 3= Left wider than right 7= Unable to test
416 rightsup VISUAL FIELDS [EXAMINER: Test each quadrant separately by confrontation with both eyes open. Wiggle fingers in the middle of each quadrant for one second and ask the subject to look at the fingers. If the subject is unable to comply, note whether the subject attends the wiggling fingers.] 1. Right superior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
417 rightinf 2. Right inferior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
418 leftsup 3. Left superior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
419 leftinf 4. Left inferior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
420 rarmrest RESTING TREMOR [EXAMINER: Instruct the subject to sit completely relaxed and to count aloud backwards from 10. Observe the hands and feet for rhythmic tremor.] 1. Right arm rest tremor 1= Absent 2= Possible rest tremor 3= Slight and infrequently present 4= Mild in amplitude and persistent, or moderate in amplitude, but only intermittently present 5= Moderate in amplitude and present most of the time 6= Marked in amplitude and present most of the time 7= Unable to test 8= Unable to determine
421 larmrest 2. Left arm rest tremor 1= Absent 2= Possible rest tremor 3= Slight and infrequently present 4= Mild in amplitude and persistent, or moderate in amplitude, but only intermittently present 5= Moderate in amplitude and present most of the time 6= Marked in amplitude and present most of the time 7= Unable to test 8= Unable to determine
422 rlegrest 3. Right leg rest tremor 1= Absent 2= Possible rest tremor 3= Slight and infrequently present 4= Mild in amplitude and persistent, or moderate in amplitude, but only intermittently present 5= Moderate in amplitude and present most of the time 6= Marked in amplitude and present most of the time 7= Unable to test 8= Unable to determine
423 llegrest 4. Left leg rest tremor 1= Absent 2= Possible rest tremor 3= Slight and infrequently present 4= Mild in amplitude and persistent, or moderate in amplitude, but only intermittently present 5= Moderate in amplitude and present most of the time 6= Marked in amplitude and present most of the time 7= Unable to test 8= Unable to determine
424 chinjaw 5. Chin/jaw rest tremor 1= Absent 2= Possible rest tremor 3= Slight and infrequently present 4= Mild in amplitude and persistent, or moderate in amplitude, but only intermittently present 5= Moderate in amplitude and present most of the time 6= Marked in amplitude and present most of the time 7= Unable to test 8= Unable to determine
425 rhanddys FINGER-TO-FINGER [EXAMINER: Instruct the subject to touch his or her index finger to your finger. The subject should extend the arm completely. Observe for dysmetria and action tremor. Score action tremor in next question.] 1. Right hand 1= No dysmetria 2= Possible dysmetria 3= Definite dysmetria 4= Unable to assess due to weakness 7= Unable to test
426 lhanddys 2. Left hand 1= No dysmetria 2= Possible dysmetria 3= Definite dysmetria 4= Unable to assess due to weakness 7= Unable to test
427 rhandact POSTURAL/ACTION TREMOR OF HANDS [EXAMINER: Instruct the subject to hold his or her arms perpendicular to body with the palms down and fingers spread apart for 10 seconds. Observe for postural tremor. Score both action and postural tremors. Record most severe tremor.] 3. Right hand 1= Absent 2= Possible 3= Present 4= Unable to test due to weakness
428 rhamp 3a. Amplitude 1= Slight 2= Mild 3= Moderate 4= Marked
429 rhaorp 3b. Posture/Action 1= Action only 2= Posture only 3= Action AND posture
430 rhfreq 3c. Frequency 1= Slow [<7 Hz] 2= Moderate [7-10 Hz] 3= Fast [>10 Hz]
431 lhandact 4. Left hand 1= Absent 2= Possible 3= Present 4= Unable to test due to weakness
432 lhamp 4a. Amplitude 1= Slight 2= Mild 3= Moderate 4= Marked
433 lhaorp 4b. Posture/Action 1= Action only 2= Posture only 3= Action AND posture
434 lhfreq 4c. Frequency 1= Slow [<7 Hz] 2= Moderate [7-10 Hz] 3= Fast [>10 Hz]
435 scptrem 0 .. 8
436 scrtrem 0 .. 30
437 ilptrem String[6]
438 ilrtrem String[6]
439 mposttrm 0 .. 2
440 mresttrm 0 .. 5
441 tapintro BRADYKINESIA Finger taps [EXAMINER: Subject taps thumb with index finger in rapid succession with widest amplitude possible for 10 seconds. Observe amplitude and speed of movement.] [Press enter to continue.] String[1]
442 rfingtap BRADYKINESIA-Finger taps 1. Right 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
443 lfingtap BRADYKINESIA-Finger taps 2. Left 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
444 rfist Fist clench [EXAMINER: Subject opens and closes fist as widely and as rapidly as possible for 10 seconds. Observe for speed and amplitude of movement.] 3. Right 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
445 lfist 4. Left 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
446 rprosup Pronation-Supination [EXAMINER: Instruct subject to alternately tap the front and back of his or her hand on his or her knee for 10 seconds. Observe for speed, amplitude and rhythmicity of movement.] 5. Right 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
447 lprosup 6. Left 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
448 rheeltap Leg agility [EXAMINER: Subject taps heel on ground in rapid succession for 10 seconds. Picks up entire leg. Amplitude should be about three inches.] 7. Right heel tap 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
449 lheeltap 8. Left heel tap 1= Normal 2= Slowing OR reduction in amplitude which could be normal 3= Mild slowing AND reduction in amplitude 4= Moderately impaired. Definite early fatiguing. May have occasional arrests in movement. 5= Severely impaired. Frequent hesitation in initiating movements. 6= Can barely perform the task. 7= Unable to test.
450 scbrady 0 .. 70
451 ilbrady String[6]
452 mbrady 0 .. 8
453 rarm STRENGTH [EXAMINER: When testing strength, push or pull for 2 seconds] Arm strength [EXAMINER: Instruct the subject to sit with both arms extended in front of the body with the palms facing upward and the fingers spread apart for 10 seconds. Observe for weakness and asymmetry.] 1. Right arm drift *******NOTE: BE SURE YOU ARE CODING EVERYTHING ACCORDING TO THE >>SUBJECT'S<< RIGHT OR LEFT SIDE. 1= No weakness 2= Possible weakness 3= Definite weakness, but elevates arm 10 seconds 4= Elevates arm less than 10 seconds 5= Unable to elevate arm 7= Unable to test
454 larm 2. Left arm drift 1= No weakness 2= Possible weakness 3= Definite weakness, but elevates arm 10 seconds 4= Elevates arm less than 10 seconds 5= Unable to elevate arm 7= Unable to test
455 armsym 3. Arm drift symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
456 neckrig HYPERTONICITY [EXAMINER: Judged on passive movement of the extremities with subject relaxed in a sitting position.] 1. Neck Rigidity 1= Absent 2= Slight, questionably present 3= Mild to moderate 4= Marked, but full range of motion achieved easily 5= Severe, full range of motion achieved with difficulty 7= Unable to test
457 neckcog 1a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
458 rarmrig 2. Right arm rigidity present in flexors AND extensors 1= Absent 2= Slight, questionably present 3= Mild to moderate 4= Marked, but full range of motion achieved easily 5= Severe, full range of motion achieved with difficulty 7= Unable to test
459 rarmcog 2a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
460 rarmspas 3. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
461 larmrig 5. Left arm rigidity present in flexors AND extensors 1= Absent 2= Slight, questionably present 3= Mild to moderate 4= Marked, but full range of motion achieved easily 5= Severe, full range of motion achieved with difficulty 7= Unable to test
462 larmcog 5a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
463 larmspas 6. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
464 rlegrig 8. Right leg rigidity present in flexors AND extensors 1= Absent 2= Slight, questionably present 3= Mild to moderate 4= Marked, but full range of motion achieved easily 5= Severe, full range of motion achieved with difficulty 7= Unable to test
465 rlegcog 8a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
466 rlegspas 9. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
467 llegrig 11. Left leg rigidity present in flexors AND extensors 1= Absent 2= Slight, questionably present 3= Mild to moderate 4= Marked, but full range of motion achieved easily 5= Severe, full range of motion achieved with difficulty 7= Unable to test
468 llegcog 11a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
469 llegspas 12. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
470 scrigid 0 .. 25
471 ilrigid String[6]
472 mrigid 0 .. 5
473 rbiceps DEEP TENDON REFLEXES 1. Right Biceps 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
474 lbiceps 2. Left Biceps 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
475 bicepsym 3. Biceps symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
476 rtriceps 7. Right Triceps 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
477 ltriceps 8. Left Triceps 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
478 tricpsym 9. Triceps symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
479 rpatella 10. Right Patella 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
480 lpatella 11. Left Patella 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
481 patelsym 12. Patella symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
482 rachill 13. Right achilles 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
483 lachill 14. Left achilles 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
484 achilsym 15. Achilles symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
485 rbigtoe BABINSKI SIGN 1. Right big toe 1= Normal 2= Possible 3= Present 7= Unable to test
486 lbigtoe 2. Left big toe 1= Normal 2= Possible 3= Present 7= Unable to test
487 bmd1 Clinical Bone Sonometer Bone Mineral Density (BMD) Trial 1 _____ g/cm2 [Enter 7 for tried but unable.] 0.000 .. 7.000
488 tscore1 Trial 1 Record T score ______ -5.0 .. 4.0
489 qui1 Trial 1 Record Quality Ultrasound Index (QUI)/stiffness _____ -50.0 .. 200.0
490 bua1 Trial 1 Record broad band ultrasound attenuation (BUA) _____dB/MHz 0.0 .. 200.0
491 sos1 Trial 1 Record speed of sound (SOS) _____ m/sec 800.0 .. 2500.0
492 soncom Clinical Bone Sonometer- Check scores and make comments. Bone Mineral Density(BMD)** ^bmd1 T score******************** ^tscore1 QUI/stiffness************** ^qui1 BUA************************ ^bua1 SOS************************ ^sos1 Page up and re-enter if any values are not correct. Enter any comments.[Press enter to continue if none.] String[250]
493 rtoevib SENSORY FUNCTION Vibratory sensation 1. Right big toe [EXAMINER: First, make sure that subject understands the sensation. Tap tuning fork in palm of hand and test for ability to perceive vibration on the top of the large toe of each foot.] 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 7= Unable to test
494 ltoevib Vibratory sensation 2. Left big toe 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 7= Unable to test
495 rlegvib Stocking pattern of vibratory loss 3. Right Leg. [EXAMINER: Determine whether there is a greater sensory loss in the toe vs. the ankle] 1= Yes 2= Possible 3= No
496 ltlegvib Stocking pattern of vibratory loss 4. Left leg. [EXAMINER: Determine whether there is a greater sensory loss in the toe vs. the ankle] 1= Yes 2= Possible 3= No
497 hpinsym Pin sensation 1. Back of index fingers symmetric 1= Yes 2= Right with less sensation than left 3= Left with less sensation than right 7= Unable to test
498 rhandpin Pin sensation 2. Right Index vs. Pinky [EXAMINER: Now instruct the subject that you will test the sensation of the index and pinky fingers. Ask the subject to tell you whether they feel the same; if they are different, where does he or she feel it more, the index finger or the small finger.] 1= Same 2= Index possible more than pinky 3= Index definitely more than pinky 4= Pinky possibly more than index 5= Pinky definitely more than index
499 lhandpin Pin sensation 3. Left Index vs. Pinky 1= Same 2= Index possible more than pinky 3= Index definitely more than pinky 4= Pinky possibly more than index 5= Pinky definitely more than index
500 fpinsym Pin sensation 4. Top of big toe symmetric 1= Yes 2= Right with less sensation than left 3= Left with less sensation than right 7= Unable to test
501 rlegpin Stocking pattern of pin loss 5. Right Leg. [EXAMINER: Tell the subject that he or she will feel the pin on the toe and ankle. Determine whether it is the same or different -- consistent with a stocking pattern of sensory loss.] 1= Yes 2= Possible 3= No
502 ltlegpin Stocking pattern of pin loss 6. Left leg. 1= Yes 2= Possible 3= No
503 rarmabd1 Nicholas MMT [CHECK CALIBRATION OR RESET INTSTRUMENT 1. Right arm abduction [DELTOID] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
504 larmabd1 2. Left arm abduction [DELTOID] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
505 rarmabd2 3. Right arm abduction [DELTOID] Trial 2 - Enter 95.5 for tried, but unable 0.1 .. 95.5
506 larmabd2 4. Left arm abduction [DELTOID] Trial 2 - Enter 95.5 for tried, but unable 0.1 .. 95.5
507 rarmflx1 Right arm flexion [BICEPS] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
508 larmflx1 Left arm flexion [BICEPS] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
509 rarmext1 Right arm extension [TRICEPS] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
510 larmext1 Left arm extension [TRICEPS] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
511 rhipflx1 5. Right hip flexion [ILIOPSOAS] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
512 lhipflx1 6. Left hip flexion [ILIOPSOAS] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
513 rhipflx2 7. Right hip flexion [ILIOPSOAS] Trial 2 - Enter 95.5 for tried, but unable 0.1 .. 95.5
514 lhipflx2 8. Left hip flexion [ILIOPSOAS] Trial 2 - Enter 95.5 for tried, but unable 0.1 .. 95.5
515 rlegext1 9. Right leg extension [QUADRICEPS] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
516 llegext1 10. Left leg extension [QUADRICEPS] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
517 rfotflx1 13. Right foot plantar flexion [GASTROCNEMIUS] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
518 lfotflx1 14. Left foot plantar flexion [GASTROCNEMIUS] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
519 rfotflx2 15. Right foot plantar flexion [GASTROCNEMIUS] Trial 2 - Enter 95.5 for tried, but unable 0.1 .. 95.5
520 lfotflx2 16. Left foot plantar flexion [GASTROCNEMIUS] Trial 2 - Enter 95.5 for tried, but unable 0.1 .. 95.5
521 rfotdor1 Right foot dorsiflexion [TIBIALIS ANTERIOR] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
522 lfotdor1 Left foot dorsiflexion [TIBIALIS ANTERIOR] Trial 1 - Enter 95.5 for tried, but unable 0.1 .. 95.5
523 rfotdor2 Right foot dorsiflexion [TIBIALIS ANTERIOR] Trial 2 - Enter 95.5 for tried, but unable 0.1 .. 95.5
524 lfotdor2 Left foot dorsiflexion [TIBIALIS ANTERIOR] Trial 2 - Enter 95.5 for tried, but unable 0.1 .. 95.5
525 muscls01 17. List all muscles you were unable to break 1= Right Deltoid 2= Left Deltoid 3= Right Bicep 4= Left Bicep 5= Right Tricep 6= Left Tricep 7= Right Hip Flexion 8= Left Hip Flexion 9= Right Leg Extension 10= Left Leg Extension 11= Right Plantar Flexion 12= Left Plantar Flexion 13= Right Dorsiflexion 14= Left Dorsiflexion 15= N/A
526 muscls02 17. List all muscles you were unable to break See previous question
527 muscls03 17. List all muscles you were unable to break See previous question
528 muscls04 17. List all muscles you were unable to break See previous question
529 muscls05 17. List all muscles you were unable to break See previous question
530 muscls06 17. List all muscles you were unable to break See previous question
531 muscls07 17. List all muscles you were unable to break See previous question
532 muscls08 17. List all muscles you were unable to break See previous question
533 muscls09 17. List all muscles you were unable to break See previous question
534 muscls10 17. List all muscles you were unable to break See previous question
535 muscls11 17. List all muscles you were unable to break See previous question
536 muscls12 17. List all muscles you were unable to break See previous question
537 muscls13 17. List all muscles you were unable to break See previous question
538 muscls14 17. List all muscles you were unable to break See previous question
539 mmtcom Nicholas MMT Enter any comments. [Press enter to continue if none.] String[250]
540 chairup POSTURE/GAIT 1. Arising from a chair [EXAMINER: Seat the subject in a straight back chair with arms. Instruct him or her to cross his or her arms across his or her chest, and to stand from the chair. If he or she is unable to do this, he or she may stand using his or her hands.] 1= Normal 2= Slow, could be normal 3= Needs more than 1 attempt, but does not push with arms 4= Pushes self up from arms of chair 5= Using arms, tends to fall back or requires more than one attempt, but able to stand without help 6= Unable to arise without help 7= Unable to test
541 basegait Gait [EXAMINER: Ask the subject to walk as fast as possible (about 10 feet), turn around and walk back. Observe speed, associated movements and base.] 2. Base 1= Normal, medial malleoli within 3 inches 2= Slightly widened, medial malleoli 3-6 inches apart 3= Widened, medial melleoli > 6 inches apart 7= Unable to test
542 shufgait 3. Shuffling Gait [EXAMINER: Loss of heel-toe walk with low foot clearance.] 1= None 2= Walks slowly, may take short steps. Could be normal 3= Walks slowly, shuffles, no festination or propulsion 4= Walks with difficulty, shuffles, may festinate or propulse, requires no assistance 5= Severe disturbance of gait, shuffles, may festinate or propulse, unable to ambulate without assistance 6= Cannot walk at all due to shuffling gait, not even with assistance
543 armswing 3a. Reduced Armswing 1= Yes 2= Suspect 3= No 7= Unable to test
544 armside 3b. On which side is the armswing reduced? 1= Right 2= Left 3= Both
545 legcirc 4. Circumduction of Leg 1= Yes 2= Suspect 3= No 7= Unable to test
546 legside 4a. On which side is this? 1= Right 2= Left 3= Both
547 body 5. Body bradykinesia/hypokinesia [EXAMINER: This item represents a global view of the slowness and deliberateness of the subject's movements. During the examination, observe the rapidity of movements, also observe decrease in armswing and spontaneous movements.] 1= None 2= Minimal slowness, giving movement a deliberate character, possibly reduced amplitude 3= Mild degree of slowness and poverty of movement which is definitely abnormal, alternatively, some reduced amplitude 4= Moderate slowness, poverty or small amplitude of movement 5= Marked slowness, poverty or small amplitude of movement
548 turning 6. Turning 1= Pivots on narrow base 2= Hesitates or widens base, but steady 3= Turns slowly and awkwardly 4= Would likely fall without aid 5= Cannot turn 7= Unable to test
549 gaitspec 10. Other gait abnormality [Press enter to continue if none.] String[40]
550 posture 1. Posture [EXAMINER: View the subject from the front and from the side.] 1= Normal erect 2= Slightly stooped posture, could be normal 3= Moderately stooped, can be leaning slightly to one side 4= Severely stooped with kyphosis, can be moderately leaning to one side 5= Marked flexion with extreme abnormality of posture 7= Unable to test
551 introstb 2. Postural Stability [EXAMINER: Instruct the subject to stand with the feet about 6 inches apart. Instruct him or her that you will be pulling back on his or her shoulders and that he or she should `try not to fall.' Standing behind the subject, pull on the shoulders with increasing strength until the subject loses his or her balance. Note the number of steps and the strength of the pull.] [PRESS ENTER TO SCORE.] String[1]
552 stblpost 2. Postural Stability 1= Normal, takes 1 step to correct balance 2= Possible retropulsion, takes 2 steps to correct balance 3= Definite retropulsion, takes 3 or more steps, but recovers unaided 4= Would fall if not caught 5= Unstable, tends to lose balance spontaneously 6= Unable to stand without assistance
553 numsteps 2a. NUMBER OF STEPS 3 .. 20
554 pull 2b. Strength of pull 1= Very light pull 2= Mild to moderate pull 3= Moderate to strong pull 4= Strong pull
555 screflex 0 .. 35
556 ilreflex String[6]
557 mreflex 0 .. 6
558 bedtime Sleep Questionnaire 1. During the past month, when have you usually gone to bed at night? Time (hh:mm) [INTERVIEWER If P responds with a range of time for bedtime, take the average. For example, if P indicates a bedtime between 10:30 pm-11:00 pm, enter 10:45 pm as the average bedtime. ] String[5]
559 bedtime_ 1. During the past month, when have you usually gone to bed at night? 1a. [am/pm] String[2]
560 min2slee 2. During the past month, how long (in minutes) has it usually taken you to fall asleep each night? [Number of minutes] [INTERVIEWER If P responds with a range of minutes, take the average.] 0 .. 999
561 getuptim 3. During the past month, when have you usually gotten up in the morning? Time (hh:mm) [INTERVIEWER If P responds with a range of time for getting up time, take the average. ] String[5]
562 getupti2 3. During the past month, when have you usually gotten up in the morning? 3a. [am/pm] String[2]
563 sleephrs 4. During the past month, how many hours did you usually sleep at night? [hours] [INTERVIEWER If P responds with a range of time, take the average. ] 0 .. 23
564 sleephr2 4. During the past month, how many hours did you usually sleep at night? 4a. [minutes] 0 .. 59
565 trsleep_ 5. How often do you have trouble falling asleep? 1= Never 2= Rarely 3= Sometimes 4= Often 5= Very often
566 trsleep3 6. During the past month, how often did you have trouble falling asleep within 30 minutes? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
567 wakenigh 7. How often are you troubled by waking up during the night? 1= Never 2= Rarely 3= Sometimes 4= Often 5= Very often
568 wakenig2 8. During the past month, how often did you wake up in the middle of the night or early morning? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
569 rested_f 9. How often do you feel really rested when you wake up in the morning? 1= Never 2= Rarely 3= Sometimes 4= Often 5= Very often
570 tiredaft 10. During the past month, how often have you felt tired or fatigued after sleep? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
571 tiredwak 11. In the past month, during your waking time, how often have you felt tired, fatigued or not up to par? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
572 nap_freq 12. How often do you get so sleepy during the day or evening that you have to take a nap? 1= Never 2= Rarely 3= Sometimes 4= Often 5= Very often
573 sleepdri 13. Have you ever nodded off or fallen asleep while driving a vehicle? 0= No 1= Yes
574 sleepdr2 13a. Over the past month, how often has this occurred? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
575 psqi_med 14. Have you used sleeping medications in two weeks prior to this interview? 0= No 1= Yes
576 snore 15. Do you snore? 0= No 1= Yes 9= Don't know
577 snorebot 15a. Has your snoring ever bothered other people? 0= No 1= Yes 9= Don't know
578 snorerat 15b. If you snore, would you say your snoring is _____ ? 1= Slightly louder than breathing 2= As loud as talking 3= Louder than talking 4= Very loud - can be heard in adjacent rooms 99= DK
579 snore_fr 15c. Over the past month, how often have you been snoring? 1= NOT AT ALL 2= LESS THAN ONCE A WEEK 3= ONCE OR TWICE A WEEK 4= THREE OR MORE TIMES A WEEK 5= NEARLY EVERY DAY 99= DK
580 breathpa 16. During the past month, how often have others noticed that you quit breathing or have long pauses between breaths during sleep? 1= NOT AT ALL 2= LESS THAN ONCE A WEEK 3= ONCE OR TWICE A WEEK 4= THREE OR MORE TIMES A WEEK 5= NEARLY EVERY DAY 99= DK
581 sleepapn 17. Are you currently being treated for sleep apnea (e.g. CPAP)? 0= No 1= Yes
582 actdream Mayo Sleep Questionnaire ? Please mark ?Yes? if the described event has occurred at least 3 times. 18 . Have you ever been told that you appear to 'act out your dreams' while sleeping? (Punched or flailed arms in the air, shouted or screamed) 0= No 1= Yes
583 actdrea2 18a. How many months or years has this been going on? [Years] 0 .. 99
584 actdrea3 18a. How many months or years has this been going on? [Months] 18a-1. [Months] 0 .. 11
585 actdrea4 18b. Have you ever been injured from these behaviors (bruises, cuts, broken bones)? 0= No 1= Yes
586 actdrea5 18c. Has your bed-partner ever been injured from these behaviors (bruises, blows, pulled hair)? 0= No 1= Yes
587 dreamatt 18d. Have you ever had dreams about being attacked, or that involved defending yourself? 0= No 1= Yes
588 movdream 18e. Have you ever been told that the movements you made matched the details of your dream? 0= No 1= Yes
589 sleepwal 19. Have you ever been told that you walked around the bedroom or house while asleep? (please mark Yes if the described event has occurred at least 3 times) 0= No 1= Yes
590 sleepwa2 19a. If yes, how often does this occur? 0= Almost never 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
591 legtwitc 20. During the past month, how often have your legs repeatedly jerked or twitched during sleep (not just while falling asleep)? 1= NOT AT ALL 2= LESS THAN ONCE A WEEK 3= ONCE OR TWICE A WEEK 4= THREE OR MORE TIMES A WEEK 5= NEARLY EVERY DAY 99= DK
592 legdisru 21. During the past month, how often have you had a restless, nervous, tingly, or creepy-crawly feeling in your legs that disrupts your ability to fall or stay asleep? 1= Not at all 2= Less than once a week 3= Once or twice a week 4= Three or more times a week 5= Nearly every day
593 legdisr2 21a. Do these leg sensations decrease when you walk around? 0= No 1= Yes
594 legdisr3 21b. When do these sensations seem to be the worst? 1= Before 6pm 2= After 6pm
595 howwell 1. INTERVIEWER OBSERVATIONS How well do you think the participant understood the questions? 1= Quite well 2= Fairly well 3= Somewhat 4= Very Little 5= Not at all
596 hearimp 2. Does the participant have a SUBSTANTIAL hearing impairment? 1= Yes 2= No
597 visimp 3. Does the participant have a SUBSTANTIAL visual impariment? 1= Yes, completely blind 2= Yes, very poor 3= Yes, poor 4= No, not substantial
598 phyeffrt 4. How great an effort do you think the participant put into the examination? 1= A great deal 2= A considerable amount 3= A moderate amount 4= A little bit 5= Hardly any
599 comm Comments. String[120]
600 autotm1 [COMPUTER CLOCK TIME] String[8]
601 report1 CLIN EVAL SUMMARY: SUBJECT ^intro.projid; Date: ^intro.dateint SUMM PG 1/10 AREA IMPAIRMENT LEVEL RANGE SCORE (Missing~) Bradykinesia ^VBrady 8-48 ^brady.ScBrady (^brady.mbrady of 8) Postural Reflex ^Vreflex 6-32 ^sensgait.Screflex^x1 (^sensgait.mreflex of 6) Rigidity ^Vrigid 5-25 ^hyper.ScRigid^x2 (^hyper.mrigid of 5) [~NOTE: If any data are missing, this will affect the computation of the impairment level.] >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
602 report2 CLIN EVAL SUMMARY: SUBJECT ^intro.projid; Date: ^intro.dateint SUMM PG 2/10 AREA IMPAIRMENT LEVEL RANGE SCORE (Missing~) Postural tremor ^Vptrem 0-8 ^tremor.Scptrem (^tremor.mposttrm of 2) Resting tremor ^Vrtrem 5-30 ^tremor.Scrtrem^x3 (^tremor.mresttrm of 5) Parkinsonism: ^Parkvar ^ps1^ps2^ps4^ps7^ps10 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
603 report3 HISTORY FROM CLIN EVAL: SUBJECT ^intro.projid; Date: ^intro.dateint SUMM PG 3/10 Stroke: ^strovar ^s1^s2^s3^s4^s6^s9^s12^s15^cervasc.symps0fu^s17 Current Drugs: ^drugvar^drugs.RXs.medicine[1].name00 ^drugs.RXs.medicine[2].name00 ^drugs.RXs.medicine[3].name00 ^drugs.RXs.medicine[4].name00 ^drugs.RXs.medicine[5].name00 ^drugs.RXs.medicine[6].name00 ^drugs.RXs.medicine[7].name00 ^drugs.RXs. medicine[8].name00 ^drugs.RXs.medicine[9].name00 ^drugs.RXs.medicine[10].name00 ^drugs.RXs.medicine[11].name00 ^drugs.RXs.medicine[12].name00 ^drugs.RXs.medicine[13].name00 ^drugs.RXs.medicine[14].name00 ^drugs.RXs.medicine[15].name00 ^drugs.RXs. medicine[16].name00 ^drugs.RXs.medicine[17].name00 ^drugs.RXs.medicine[18].name00 ^drugs.RXs.medicine[19].name00 ^drugs.RXs.medicine[20].name00 PRESS ENTER FOR NEXT SUMMARY SCREEN
604 report3a HISTORY FROM CLIN EVAL: SUBJECT ^intro.projid; Date: ^intro.dateint SUMM PG 3a/10 Stroke with hospitalization: ^strovar2 ^s201^s202^s203^s204^s205^s206^s208^s209^s211^s212^s214^s215 ^cervasc.symps1fu^s217 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
605 report3b HISTORY FROM CLIN EVAL: SUBJECT ^intro.projid; Date: ^intro.dateint SUMM PG 3b/10 Stroke with brain scan: ^strovar3 ^s301^s302^s303^s304^s305^s306^s308^s309^s311^s312^s314^s315 ^cervasc.symps2fu^s317 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
606 report4 NEURO EXAM - FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 4/10 CRANIAL NERVES ^normal^a5^a6^a7^a8 Brain scan: ^scanvar ^reason ^whyscan^cervasc.reasonfu PRESS ENTER FOR NEXT SUMMARY SCREEN
607 report5 NEURO EXAM - FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 5/10 Seventh Nerve: ^normal ^c1^d1^c2^d2^c3^d3^c4^d4 Tongue: ^c5^d5 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
608 report6 NEURO EXAM - FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 6/10 FOCAL SIGNS: ARM STRENGTH SYMMETRY ^normal2^e1^f1^e2^f2^e3^f3^e4^e5^e6^g1^g2^g3 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
609 report7 NEURO EXAM - FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 7/10 FOCAL SIGNS: LEG STRENGTH SYMMETRY ^normal2^e2^g4^h4^g5^h5^g6^h6^i4^i5^i6^j4^j5^j6^a5 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
610 report8 NEURO EXAM - FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 8/10 DEEP TENDON REFLEXES: ^normal2 ^g4^h4^g5^h5^g6^h6^g7^h7^g8^h8 BABINSKI SIGN: ^normal3 ^k1^k2 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
611 report9 NEURO EXAM-FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 9/10 SENSORY FUNCTION Pin Sensation: ^normal1 ^a1^b1^a2^b2 Vibratory Sensation: ^normal3^a6 ^a7 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
612 report10 NEURO EXAM-FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 10/10 CEREBELLAR FUNCTION FINGER-TO-FINGER: ^normal1 ^a1^a2 HEEL-TO-SHIN TEST: ^normal2 ^a3^a4 GAIT: ^normal3^a5 ^a6^a7 >>>>> END OF SUMMARY SECTION <<<<
613 formcode Please enter status code. 11 = COMPLETE 13 = COMPLETE, portion with proxy 12 = INCOMPLETE, refused 14 = INCOMPLETE, too impaired 21 = INCOMPLETE interim, complete later 73 = NOT TESTED, out of town 31 = NOT TESTED, moved 33 = NOT TESTED, refused 75 = NOT TESTED, hospitalized 76 = NOT TESTED, other 42 = DECEASED 43 = WITHDRAWN 44 = WITHDRAWN, Autopsy OK 11 .. 76
614 formpart Was participant reluctant, and/or does participant have special needs? 1= Yes 2= No
615 formcomm Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] String[120]
616 statid Please enter you staff id. 100 .. 997
617 formch Has the form been modified? 1= Yes 2= No
618 revidate Enter the date that the form was modified. Date type
619 revintd Enter your staff id number. 100 .. 997

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