Data Dictionary for marcev

Number of Blaise fields: 594

Seq # Var Question Data Type/Coding
1 projid MARS Baseline Clinical Evaluation (Version: 03/02/2022) Enter project ID number. String[8]
2 folder Type in folder color. F/U Year Folder Baseline (manilla) String[8]
3 visit Enter visit code (check folder color): CODE F/U Year Folder 00 = Baseline (manilla) String[2]
4 vervisit Please verify visit and folder color. visit = ^visitnum folder = ^folder1 Is this correct? If not, please page up and correct folder color. 1= Yes
5 formno Form Number String[6]
6 version Version Number String[4]
7 autodate Automatic Date. Date type
8 autotime Automatic Time. TimeType
9 autolog Automatic Logged Date. Date type
10 intid INTERVIEWER ID 100 .. 997
11 compid Laptop ID String[20]
12 dateint Date of interview Date type
13 sex Subject's sex. 1= Male 2= Female
14 autotm [COMPUTER CLOCK TIME] String[8]
15 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
16 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
17 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
18 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
19 name00 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
20 stren00 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
21 drgnm00 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
22 seen00 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
23 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
24 recd00 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
25 name01 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
26 stren01 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
27 drgnm01 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
28 seen01 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
29 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
30 recd01 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
31 name02 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
32 stren02 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
33 drgnm02 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
34 seen02 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
35 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
36 recd02 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
37 name03 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
38 stren03 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
39 drgnm03 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
40 seen03 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
41 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
42 recd03 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
43 name04 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
44 stren04 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
45 drgnm04 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
46 seen04 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
47 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
48 recd04 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
49 name05 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
50 stren05 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
51 drgnm05 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
52 seen05 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
53 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
54 recd05 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
55 name06 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
56 stren06 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
57 drgnm06 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
58 seen06 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
59 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
60 recd06 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
61 name07 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
62 stren07 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
63 drgnm07 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
64 seen07 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
65 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
66 recd07 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
67 name08 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
68 stren08 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
69 drgnm08 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
70 seen08 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
71 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
72 recd08 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
73 name09 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
74 stren09 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
75 drgnm09 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
76 seen09 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
77 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
78 recd09 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
79 name10 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
80 stren10 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
81 drgnm10 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
82 seen10 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
83 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
84 recd10 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
85 name11 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
86 stren11 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
87 drgnm11 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
88 seen11 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
89 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
90 recd11 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
91 name12 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
92 stren12 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
93 drgnm12 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
94 seen12 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
95 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
96 recd12 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
97 name13 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
98 stren13 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
99 drgnm13 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
100 seen13 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
101 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
102 recd13 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
103 name14 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
104 stren14 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
105 drgnm14 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
106 seen14 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
107 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
108 recd14 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
109 name15 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
110 stren15 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
111 drgnm15 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
112 seen15 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
113 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
114 recd15 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
115 name16 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
116 stren16 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
117 drgnm16 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
118 seen16 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
119 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
120 recd16 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
121 name17 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
122 stren17 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
123 drgnm17 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
124 seen17 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
125 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
126 recd17 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
127 name18 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
128 stren18 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
129 drgnm18 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
130 seen18 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
131 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
132 recd18 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
133 name19 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
134 stren19 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
135 drgnm19 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
136 seen19 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
137 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
138 recd19 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
139 name20 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
140 stren20 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
141 drgnm20 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
142 seen20 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
143 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
144 recd20 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
145 name21 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
146 stren21 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
147 drgnm21 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
148 seen21 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
149 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
150 recd21 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
151 name22 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
152 stren22 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
153 drgnm22 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
154 seen22 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
155 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
156 recd22 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
157 name23 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
158 stren23 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
159 drgnm23 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
160 seen23 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
161 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
162 recd23 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
163 name24 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
164 stren24 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
165 drgnm24 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
166 seen24 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
167 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
168 recd24 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
169 name25 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
170 stren25 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
171 drgnm25 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
172 seen25 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
173 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
174 recd25 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
175 name26 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
176 stren26 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
177 drgnm26 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
178 seen26 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
179 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
180 recd26 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
181 name27 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
182 stren27 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
183 drgnm27 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
184 seen27 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
185 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
186 recd27 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
187 name28 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
188 stren28 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
189 drgnm28 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
190 seen28 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
191 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
192 recd28 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
193 name29 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
194 stren29 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
195 drgnm29 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
196 seen29 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
197 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
198 recd29 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
199 name30 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
200 stren30 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
201 drgnm30 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
202 seen30 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
203 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
204 recd30 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
205 name31 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
206 stren31 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
207 drgnm31 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
208 seen31 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
209 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
210 recd31 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
211 name32 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
212 stren32 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
213 drgnm32 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
214 seen32 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
215 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
216 recd32 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
217 name33 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
218 stren33 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
219 drgnm33 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
220 seen33 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
221 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
222 recd33 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
223 name34 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
224 stren34 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
225 drgnm34 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
226 seen34 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
227 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
228 recd34 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
229 name35 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
230 stren35 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
231 drgnm35 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
232 seen35 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
233 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
234 recd35 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
235 name36 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
236 stren36 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
237 drgnm36 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
238 seen36 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
239 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
240 recd36 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
241 name37 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
242 stren37 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
243 drgnm37 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
244 seen37 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
245 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
246 recd37 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
247 name38 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
248 stren38 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
249 drgnm38 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
250 seen38 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
251 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
252 recd38 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
253 name39 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
254 stren39 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
255 drgnm39 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
256 seen39 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
257 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
258 recd39 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
259 name40 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
260 stren40 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
261 drgnm40 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
262 seen40 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
263 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
264 recd40 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
265 name41 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
266 stren41 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
267 drgnm41 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
268 seen41 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
269 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
270 recd41 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
271 name42 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
272 stren42 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
273 drgnm42 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
274 seen42 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
275 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
276 recd42 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
277 name43 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
278 stren43 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
279 drgnm43 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
280 seen43 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
281 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
282 recd43 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
283 name44 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
284 stren44 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
285 drgnm44 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
286 seen44 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
287 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
288 recd44 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
289 name45 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
290 stren45 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
291 drgnm45 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
292 seen45 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
293 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
294 recd45 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
295 name46 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
296 stren46 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
297 drgnm46 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
298 seen46 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
299 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
300 recd46 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
301 name47 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
302 stren47 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
303 drgnm47 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
304 seen47 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
305 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
306 recd47 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
307 name48 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
308 stren48 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
309 drgnm48 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
310 seen48 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
311 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
312 recd48 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
313 name49 a1. [INTERVIEWER: NAME OF MEDICINE] String[50]
314 stren49 a2. [INTERVIEWER: ENTER STRENGTH] String[10]
315 drgnm49 b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] 1= Yes 2= No
316 seen49 c. [INTERVIEWER: IS DRUG SEEN?] 1= Yes 2= No
317 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
318 recd49 e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] String[40]
319 q8atap FINGER TAPPING [TURN DIAL TO TAPPING TEST] 1. Right hand. '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
320 q8ana Specify reason. String[40]
321 q8btap FINGER TAPPING [RESET TAPPER] Left hand. 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
322 q8bna Specify reason. String[40]
323 q8ctap FINGER TAPPING [RESET TAPPER] Right hand. 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
324 q8cna Specify reason. String[40]
325 q8dtap FINGER TAPPING [RESET TAPPER] Left hand. 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
326 q8dna Specify reason. String[40]
327 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
328 rhand1na Specify reason. String[40]
329 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
330 lhand1na Specify reason. String[40]
331 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
332 rhand2na Specify reason. String[40]
333 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
334 lhand2na Specify reason. String[40]
335 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
336 rthand1n Specify reason. String[40]
337 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
338 lthand1n Specify reason. String[40]
339 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
340 rthand2n Specify reason. String[40]
341 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
342 lthand2n Specify reason. String[40]
343 stroke 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. Have you EVER 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
344 strokeyr 1a. When was the last time? [ENTER YEAR] [INTERVIEWER: `Last' refers to the most recent event.] 1940 .. 2020
345 faint0 At the time of this (last) event, did you you have . . . a. Fainting, blackout or loss of consciousness? 1= Yes 2= Suspect 3= No
346 dizzy0 b. Dizzyness or lightheadedness? 1= Yes 2= Suspect 3= No
347 memory0 c. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
348 speech0 At the time of this (last) event, did you you have . . . d. Language or speech change? 1= Yes 2= Suspect 3= No
349 vision0 e. Loss of vision? 1= No 2= right only 3= left only 4= both
350 face0 f. Weakness or paralysis of your face? 1= No 2= right only 3= left only 4= both
351 weaklim0 g. Weakness or paralysis of your arms or legs? 1= No 2= right only 3= left only 4= both
352 limsens0 h. Loss or change of sensation in your arms or legs? 1= No 2= right only 3= left only 4= both
353 sympspe0 i. Specify any other signs or symptoms associated with this (last) event? String[40]
354 sametim0 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
355 samespe0 Specify: String[60]
356 inhosp 2. Have you EVER been HOSPITALIZED OVERNIGHT or longer because of a STROKE, a TIA or a BRAIN HEMORRHAGE? 1= Yes 2= Suspect 3= No
357 prompt1 2a. Was this the same event we just spoke about? 1= Yes 2= No
358 hospyear When was the last time? [ENTER YEAR] [INTERVIEWER: `Last' refers to the most recent hospitalization event.] 1940 .. 2020
359 hospname 2b. What was the name of the hospital? String[30]
360 faint1 At the time of this (last) event, did you you have . . . a. Fainting, blackout or loss of consciousness? 1= Yes 2= Suspect 3= No
361 dizzy1 b. Dizzyness or lightheadedness? 1= Yes 2= Suspect 3= No
362 memory1 c. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
363 speech1 At the time of this (last) event, did you have . . . [INTERVIEWER: `Last' refers to the most recent hospitalization event.] d. Language or speech change? 1= Yes 2= Suspect 3= No
364 vision1 e. Loss of vision? 1= No 2= right only 3= left only 4= both
365 face1 f. Weakness or paralysis of your face? 1= No 2= right only 3= left only 4= both
366 weaklim1 g. Weakness or paralysis of your arms or legs? 1= No 2= right only 3= left only 4= both
367 limsens1 h. Loss or change of sensation in your arms or legs? 1= No 2= right only 3= left only 4= both
368 sympspe1 i. Specify any other signs or symptoms associated with this (last) event? String[40]
369 sametim1 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
370 samespe1 Specify: String[60]
371 strokscn 3. Have you EVER 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
372 prompt2 3a. Was this for ^event we just spoke about? 1= Yes 2= No
373 scanyear When was the last time? [ENTER YEAR] [INTERVIEWER: `Last' refers to the most recent scan.] 1940 .. 2020
374 scanloc 3b. What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? String[30]
375 faint2 At the time of this (last) event, did you you have . . . a. Fainting, blackout or loss of consciousness? 1= Yes 2= Suspect 3= No
376 dizzy2 b. Dizzyness or lightheadedness? 1= Yes 2= Suspect 3= No
377 memory2 c. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
378 speech2 d. Language or speech change? 1= Yes 2= Suspect 3= No
379 vision2 e. Loss of vision? 1= No 2= right only 3= left only 4= both
380 face2 f. Weakness or paralysis of your face? 1= No 2= right only 3= left only 4= both
381 weaklim2 g. Weakness or paralysis of your arms or legs? 1= No 2= right only 3= left only 4= both
382 limsens2 h. Loss or change of sensation in your arms or legs? 1= No 2= right only 3= left only 4= both
383 sympspe2 i. Specify any other signs or symptoms associated with this (last) event? String[40]
384 sametim2 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
385 samespe2 Specify: String[60]
386 multiple 4. Did you have only ONE STROKE, TIA or BRAIN HEMORRHAGE, or more than one? 1= Only one 2= More than one
387 leftspec 5. Specify leftover troubles from your stroke(s)? String[60]
388 everscan 6. Have you EVER had a CT, MRI or other type of brain scan? 1= Yes 2= Suspect 3= No
389 reason 6c. Reason String[60]
390 escanloc 6d. What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? String[30]
391 parks 1. Have you EVER been told by a doctor, nurse or therapist that you had PARKINSONISM or PARKINSON'S DISEASE? 1= Yes 2= Suspect or possible 3= No
392 year 1a. When were you first told this? 1940 .. 2020
393 gait With the parkinsonism, did you have . . . 2. Shuffling or unsteady gait, or loss of balance? 1= Yes 2= Suspect 3= No
394 writing 3. A change in your handwriting? 1= Yes 2= Suspect 3= No
395 stiff 4. Stiffness or rigidity of your arms or legs? 1= No 2= right only 3= left only 4= both
396 slowmove 5. Slowness of movement of your arms, hands or legs? 1= No 2= right only 3= left only 4= both
397 tremor 6. Tremor of your hands or feet? 1= No 2= right only 3= left only 4= both
398 medicate 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
399 medspec 7a. Specify String[30]
400 admin 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. >>>>> PRESS ENTER FOR FIRST ITEM <<<<<
401 visual 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.] >>>>> PRESS ENTER FOR FIRST ITEM <<<<<
402 speech3 SPEECH 1= Normal 2= Slight loss of expression, diction and/or volume which could be normal 3= Monotone, slurred but understandable, moderately impaired 4= Marked impairment, difficult to understand 5= Unintelligible
403 dentures Is the subject missing a substantial portion of his or her natural or prosthetic dentition? 1= Yes 2= No
404 facexp FACIAL EXPRESSION 1= Normal 2= Minimal hypomimia, could be normal `poker face' 3= Slight but definitely abnormal diminution of facial expression 4= Moderate hypomimia; lips parted some of the time 5= Masked or fixed facies with severe or complete loss of facial expression; lips parted 1/4 inch or more 7= Unable to test
405 nasorest 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
406 fissures 2. Palpebral fissures 1= Symmetric 2= Right wider than left 3= Left wider than right 7= Unable to test
407 rightsup 1. Right superior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
408 rightinf 2. Right inferior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
409 leftsup 3. Left superior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
410 leftinf 4. Left inferior quadrant 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test
411 tongue TONGUE PROTRUSION [EXAMINER: Instruct the subject to open his or her mouth and stick out his or her tongue. Upper lip shuold not be in contact with tongue. The tongue will deviate to the weak side.] 1= Midline 2= Deviate right 3= Deviate left 7= Unable to test
412 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
413 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
414 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
415 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
416 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
417 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 postural/action - NEXT Q.] 1. Right hand 1= No dysmetria 2= Possible dysmetria 3= Definite dysmetria 4= Unable to assess due to weakness 7= Unable to test
418 lhanddys 2. Left hand 1= No dysmetria 2= Possible dysmetria 3= Definite dysmetria 4= Unable to assess due to weakness 7= Unable to test
419 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 or action tremor. Record most severe tremor.] 3. Right hand 1= Absent 2= Possible 3= Present 4= Unable to test due to weakness
420 rhamp 3a. Amplitude 1= Slight 2= Mild 3= Moderate 4= Marked
421 rhaorp 3b. Posture/Action 1= Action only 2= Posture only 3= Action AND posture
422 rhfreq 3c. Frequency 1= Slow [<7 Hz] 2= Moderate [7-10 Hz] 3= Fast [>10 Hz]
423 lhandact 4. Left hand 1= Absent 2= Possible 3= Present 4= Unable to test due to weakness
424 lhamp 4a. Amplitude 1= Slight 2= Mild 3= Moderate 4= Marked
425 lhaorp 4b. Posture/Action 1= Action only 2= Posture only 3= Action AND posture
426 lhfreq 4c. Frequency 1= Slow [<7 Hz] 2= Moderate [7-10 Hz] 3= Fast [>10 Hz]
427 scptrem 0 .. 8
428 scrtrem 0 .. 30
429 ilptrem String[6]
430 ilrtrem String[6]
431 mposttrm 0 .. 2
432 mresttrm 0 .. 5
433 admin2 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 <<<<<
434 rfingtap 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.
435 lfingtap 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.
436 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.
437 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.
438 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.
439 rdisdia 5a. Right disdiadochokinesia 1= Yes 2= Suspect 3= No
440 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.
441 ldisdia 6a. Left disdiadochokinesia 1= Yes 2= Suspect 3= No
442 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.
443 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.
444 scbrady 0 .. 70
445 ilbrady String[6]
446 mbrady 0 .. 8
447 admin3 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.] >>>>> PRESS ENTER TO CONTINUE <<<<< String[1]
448 rarm 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
449 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
450 armsym 3. Arm drift symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
451 rarmabd 4. Right arm abduction [deltoid] strength [EXAMINER: Stand in front of subject and instruct him or her to abduct his or her arms at the shoulders, and hold them up. Test both deltoid simultaneously] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
452 larmabd 5. Left arm abduction [deltoid] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
453 armadbsy 6. Arm abduction [deltoid] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
454 rflex 7. Right arm flexion [biceps] strength [EXAMINER: Stand in front of subject and instruct him or her to flex his or her supinated forearms, and hold them up. Test each arm separately.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
455 lflex 8. Left arm flexion [biceps] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
456 flexsym 9. Arm felxion [biceps] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
457 raext 10. Right arm extension [triceps] strength [EXAMINER: Stand in front of subject and instruct him or her to extend his or her supinated forearms at the elbow. Start with arm at 90 degree angle. Test each arm separately.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
458 laext 11. Left arm extension [triceps] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
459 extsym 12. Arm extension [triceps] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
460 rwrist 13. Right wrist extensor [extensor carpi radialis] strength [EXAMINER: Instruct subject to hold arms outstretched perpendicular to body, make a fist and `cock' his or her wrists back and hold them. Test each wrist separately.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
461 lwrist 14. Left wrist extensor [extensor carpi radialis] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
462 wristsym 15. Wrist extensor [extensor carpi radialis] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
463 rfinger 16. Right index finger strength (FDI). [EXAMINER: Instruct subject to place his or her palm and fingers flat on the table with fingers spread apart. Push on the first index finger joint. 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe
464 lfinger 17. Left index finger strength. 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe
465 rthumb 18. Right thumb strength (APB). [EXAMINER: Instruct subject to place the back of his or her hand on the table with the thumb pointed straight up. Push while subject abducts thumb toward other side of wrist. 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe
466 lthumb 19. Left thumb strength. 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe
467 rhip 20. Right hip flexion [iliopsoas] strength [EXAMINER: Stand in front of subject and instruct him or her to raise his or her leg off the chair. Test each leg separately.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
468 lhip 21. Left hip flexion [iliopsoas] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
469 hipsym 22. Hip felxion [iliopsoas] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
470 rleg Leg strength [EXAMINER: Instruct the subject to sit and extend both legs straight out for 10 seconds. Observe each leg in turn for weakness.] 23. Right leg strength *******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 leg 10 seconds 4= Elevates leg less than 10 seconds 5= Unable to elevate leg 7= Unable to test
471 lleg 24. Left leg strength 1= No weakness 2= Possible weakness 3= Definite weakness, but elevates leg 10 seconds 4= Elevates leg less than 10 seconds 5= Unable to elevate leg 7= Unable to test
472 legsym 25. Leg strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
473 rknee 26. Right knee extension strength [EXAMINER: Ask subject to straighten his or her leg; push down on ankle to check knee extension (quadriceps) strength. Test each leg separately] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
474 lknee 27. Left knee extension (quadriceps) strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
475 kneesym 28. Knee extension (quadriceps) strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
476 rankle 29. Right ankle dorsiflexion [tibialis anterior] strength [EXAMINER: Hold up subject's leg and ask subject to `cock' his or her foot back towards his or her face. Push on dorsum of foot.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
477 lankle 30. Left ankle dorsiflexion [tibialis anterior] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
478 anklesym 31. Ankle dorsiflexion [tibialis anterior] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
479 rfoot 32. Right foot plantar flexion [gastrocnemius] strength [EXAMINER: Stand in front of subject, straighten his or her legs, place your hand on ball of foot and instruct him or her to push his or her foot against your hand.] 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
480 lfoot 33. Left foot plantar flexion [gastrocnemius] strength 1= Normal 2= Moves against great resistance - minimal break-away weakness. 3= Moves against moderate resistance - moderate break-away weakness. 4= Moves only against gravity. 5= Moves if gravity eliminated. 6= No perceptible movement 7= Unable to test
481 footsym 34. Foot plantar flexion [gastrocnemius] strength symmetric 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test
482 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
483 neckcog 1a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
484 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
485 rarmcog 2a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
486 rarmgeg 2b. Rigidity in flexors and extensors increases as the examiner moves the extremity faster and harder. 1= Yes 2= Suspect 3= No 7= Unable to test
487 rarmspas 3. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
488 rarmflex 4. Flexion contracture present 1= Yes 2= Suspect 3= No 7= Unable to test
489 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
490 larmcog 5a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
491 larmgeg 5b. Rigidity in flexors and extensors increases as the examiner moves the extremity faster and harder. 1= Yes 2= Suspect 3= No 7= Unable to test
492 larmspas 6. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
493 larmflex 7. Flexion contracture present 1= Yes 2= Suspect 3= No 7= Unable to test
494 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
495 rlegcog 8a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
496 rleggeg 8b. Rigidity in flexors and extensors increases as the examiner moves the extremity faster and harder. 1= Yes 2= Suspect 3= No 7= Unable to test
497 rlegspas 9. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
498 rlegflex 10. Flexion contracture present 1= Yes 2= Suspect 3= No 7= Unable to test
499 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
500 llegcog 11a. Cogwheeling 1= Yes 2= Suspect 3= No 7= Unable to test
501 lleggeg 11b. Rigidity in flexors and extensors increases as the examiner moves the extremity faster and harder. 1= Yes 2= Suspect 3= No 7= Unable to test
502 llegspas 12. Spasticity. 1= Yes 2= Suspect 3= No 7= Unable to test
503 llegflex 13. Flexion contracture present 1= Yes 2= Suspect 3= No 7= Unable to test
504 rlegatax HEEL-TO-SHIN TEST [EXAMINER: Lower extremity ataxia is checked by the heel-to-shin test. Instruct the subject to place the heel of one foot on the opposite knee, then to slide the heel down the shin in a straight line to the foot. Observe the accuracy of touching the knee with the heel and the smoothness of the movement down the shin.] 1. Right leg ataxia 1= No dysmetria 2= Possible dysmetria 3= Definite dysmetria 4= Unable to assess due to weakness 7= Unable to test
505 llegatax Left leg ataxia 1= No dysmetria 2= Possible dysmetria 3= Definite dysmetria 4= Unable to assess due to weakness 7= Unable to test
506 scrigid 0 .. 25
507 ilrigid String[6]
508 mrigid 0 .. 5
509 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
510 lbiceps 2. Left Biceps 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
511 bicepsym 3. Biceps symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
512 rbrach 4. Right Brachioradialis 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
513 lbrach 5. Left Brachioradialis 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
514 brachsym 6. Brachioradialis symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
515 rtriceps 7. Right Triceps 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
516 ltriceps 8. Left Triceps 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
517 tricpsym 9. Triceps symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
518 rpatella 10. Right Patella 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
519 lpatella 11. Left Patella 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
520 patelsym 12. Patella symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
521 rachill 13. Right achilles 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
522 lachill 14. Left achilles 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test
523 achilsym 15. Achilles symmetric 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test
524 rbigtoe BABINSKI SIGN 1. Right big toe 1= Normal 2= Possible 3= Present 7= Unable to test
525 lbigtoe 2. Left big toe 1= Normal 2= Possible 3= Present 7= Unable to test
526 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
527 ltoevib Vibratory sensation 2. Left big toe 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 7= Unable to test
528 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
529 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
530 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
531 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
532 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
533 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
534 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
535 ltlegpin Stocking pattern of pin loss 6. Left leg. 1= Yes 2= Possible 3= No
536 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
537 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
538 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
539 armswing 3a. Reduced Armswing 1= Yes 2= Suspect 3= No 7= Unable to test
540 armside 3b. On which side is the armswing reduced? 1= Right 2= Left 3= Both
541 legcirc 4. Circumduction of Leg 1= Yes 2= Suspect 3= No 7= Unable to test
542 legside 4a. On which side is this? 1= Right 2= Left 3= Both
543 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
544 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
545 antspec Other gait abnormality: 7. Antalgic gait [EXAMINER: Limp, may be due to pain in back, hip(s), knee(s), ankle(s), foot/feet and/or toe(s).] 1= Yes 2= Suspect 3= No
546 ataxgait 8. Ataxic gait [EXAMINER: Disdiadochokinesia of gait, loss of gait rhythmicity.] 1= Yes 2= Suspect 3= No
547 neurgait 9. Neuropathic gait [EXAMINER: Steppage (equine) gait with high foot clearance.] 1= Yes 2= Suspect 3= No
548 gaitspec 10. Other gait abnormality String[40]
549 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
550 stblpost 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.] 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
551 numsteps 2a. NUMBER OF STEPS 3 .. 20
552 pull 2b. Strength of pull 1= Very light pull 2= Mild to moderate pull 3= Moderate to strong pull 4= Strong pull
553 myoclon MYOCLONUS [THIS SHOULD BE SCORED AS PRESENT ONLY IF ACTION OR RESTING MYOCLONUS IS ACTUALLY OBSERVED BY THE EXAMINER.] 1= Absent 2= Present during action or startle 3= Present at rest
554 chorea CHOREA [THIS SHOULD BE SCORED AS PRESENT ONLY IF ACTUALLY WITNESSED BY THE EXAMINER] 1= Absent 2= Possible chorea 3= Definite chorea
555 chorspec Specify: String[40]
556 screflex 0 .. 35
557 ilreflex String[6]
558 mreflex 0 .. 6
559 cov1 Revised COVID FORM 2022 This form serves as an update to the original COVID-19 Survey released in summer 2020, and reflects on several important updates since that time, including vaccinations and evolving understanding of the long-term impacts of COVID-19 particularly on cognitive function. We are asking these questions because COVID-19 has presented multiple challenges for us all, and we would like to learn about your experience. 1. Have you been diagnosed with COVID-19 (you tested positive or were presumed to have COVID-19 by a healthcare provider)? 0= No 1= Yes, based on a positive test for acute infection 2= Yes, presumed COVID-19 diagnosis by healthcare provider but not tested 8= Decline to answer 9= Unsure/unknown
560 cov1a Revised COVID FORM 2022 1a. How many times have you been diagnosed with COVID-19 (distinct episodes of illness)? 1= Once 2= Twice 3= Three or more times 9= Unsure/unknown
561 cov1b Revised COVID FORM 2022 1b. When did your first COVID-19 infection begin (month/year)? [ 88/8888 = Decline to answer ] String[7]
562 cov1c Revised COVID FORM 2022 1c. What was the duration of your first COVID-infection? 1= <1 week 2= 1-2 weeks 3= 2-4 weeks 4= >4 weeks 5= Not yet recovered (symptoms persist to the present)
563 cov1d Revised COVID FORM 2022 1d. During any of your COVID-19 infections, did you lose the ability to smell or taste, experience lower ability to determine smells or tastes, or experience episodes of unprovoked, unfamiliar, or strange smells or tastes? 0= No 1= Yes 8= Decline to answer 9= Unsure/unknown
564 cov1e Revised COVID FORM 2022 1e. During any of your COVID-19 infections, did you experience new problems with thinking, remembering, or concentration (e.g., brain fog)? 0= No 1= Yes 8= Decline to answer 9= Unsure/unknown
565 cov1f Revised COVID FORM 2022 1f. Did you ever seek medical care for COVID-19? 0= No 1= Yes 8= Decline to answer 9= Unsure/unknown
566 cov1g Revised COVID FORM 2022 1g. What was the highest level of care received? 1= Physician or urgent care visit, including virtual care visit 2= Emergency department 3= Hospitalized but not the intensive care unit 4= Hospitalized, including a stay in the ICU and/or ventilator support (breathing tube in your throat) 8= Decline to answer 9= Unsure/unknown
567 cov1h Revised COVID FORM 2022 1h. To what degree have you recovered from your COVID-19 symptoms (scale 1 to 5)? 1= No improvement 2= Slightly improved 3= Somewhat improved 4= Mostly improved 5= Totally recovered or never had symptoms 8= Decline to answer 9= Unsure/unknown
568 cov2 Revised COVID FORM 2022 2. Have you received at least one vaccination against COVID-19? 0= No 1= Yes 8= Decline to answer 9= Unsure/unknown
569 ivisit visit
570 cuff BLOODPRESSURE Now I would like to take some blood pressure readings. 3. IS CUFF SIZE AVAILABLE? [IF CUFF NOT AVAILABLE, AT END OF INTERVIEW SET UP TIME TO RETURN FOR BLOOD PRESSURE MEASUREMENT] 1= Yes 2= No
571 bp11 6. FIRST SITTING BLOOD PRESSURE READING [INTERVIEWER: The subject should be seated for five minutes prior to obtaining the seated blood pressure readings. ENTER SYSTOLIC/DIASTOLIC] String[7]
572 bp2 7. SECOND SITTING BLOOD PRESSURE READING [INTERVIEWER: ENTER SYSTOLIC/DIASTOLIC] String[7]
573 bp31 8. STANDING BLOOD PRESSURE READING [INTERVIEWER: ASK THE SUBJECT TO STAND. WAIT 60 SECONDS THEN REPEAT BLOOD PRESSURE READING. ENTER SYSTOLIC/DIASTOLIC] String[7]
574 comm Comments. String[120]
575 autotm1 [COMPUTER CLOCK TIME] String[8]
576 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 <<<<<
577 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 <<<<<
578 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.sympspe0^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
579 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.sympspe1^s217 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
580 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.sympspe2^s317 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<<
581 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.reason PRESS ENTER FOR NEXT SUMMARY SCREEN
582 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 <<<<<
583 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 <<<<<
584 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 <<<<<
585 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 <<<<<
586 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 <<<<<
587 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 <<<<
588 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
589 formpart Was participant reluctant, and/or does participant have special needs? 1= Yes 2= No
590 formcomm Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] String[120]
591 statid Please enter you staff id. 100 .. 997
592 formch Has the form been modified? 1= Yes 2= No
593 revidate Enter the date that the form was modified. Date type
594 revintd Enter your staff id number. 100 .. 997

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