Number of Blaise fields: 97
Seq # | Var | Question | Data Type/Coding |
---|---|---|---|
1 | versiondate | Version Date | |
2 | formdescr | Form Description | |
3 | formno | Form Number | String[8] |
4 | version | Version Number | String[10] |
5 | projid | ^formdescr Form: ^formno Version: ^version (^versiondate) Enter project ID number. | String[8] |
6 | 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] |
7 | baseyear | Enter year of baseline from face sheet: | 1993 .. 2025 |
8 | autodate | Automatic Date. | Date type |
9 | autotime | Automatic Time. | TimeType |
10 | autolog | Automatic Logged Date. | Date type |
11 | intid | INTERVIEWER ID | 100 .. 997 |
12 | compid | Laptop id | String[7] |
13 | dateint | Date of interview | Date type |
14 | educ | Enter subject's highest grade or year of regular school recorded in the printout from the baseline cognitive testing Elementary 0 1 2 3 4 5 6 7 8 High School 9 10 11 12 College 13 14 15 16 Graduate Professional 17 18 19 20 21 ... | 0 .. 30 |
15 | orient | NEUROPSYCHOLOGIST'S CLINICAL IMPRESSION OF COGNITIVE TESTING Record impairment of each cognitive domain and whether the neuropsychologist agreed or disagreed with the impairment level 1. Orientation | 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe 6= Missing |
16 | opinion1 | 1a. Neuropsychologist's Opinion | 1= Agree 2= Disagree |
17 | implev1 | 1b. Level of Impairment | 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe 6= Unable to determine |
18 | educat1 | 1c. Reason(s) Education Adjustment | 1= Yes 2= No |
19 | eduspf1 | Specify | String[40] |
20 | sensor1 | 1d. Sensory Impairment | 1= Yes 2= No |
21 | senspf1 | Specify | String[40] |
22 | prcoop1 | 1e. Poor Cooperation | 1= Yes 2= No |
23 | poorspf1 | Specify | String[40] |
24 | othtest1 | 1f. Other Test Scores | 1= Yes 2= No |
25 | othspf1 | Specify | String[40] |
26 | othreas1 | 1g. Other Reason(s) | 1= Yes 2= No |
27 | othrspf1 | Specify | String[40] |
28 | attentn | 2. Attention | 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe 6= Missing |
29 | opinion2 | 2a. Neuropsychologist's Opinion | 1= Agree 2= Disagree |
30 | implev2 | 2b. Level of Impairment | 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe 6= Unable to determine |
31 | educat2 | 2c. Reason(s) Education Adjustment | 1= Yes 2= No |
32 | eduspf2 | Specify | String[40] |
33 | sensor2 | 2d. Sensory Impairment | 1= Yes 2= No |
34 | senspf2 | Specify | String[40] |
35 | prcoop2 | 2e. Poor Cooperation | 1= Yes 2= No |
36 | poorspf2 | Specify | String[40] |
37 | othtest2 | 2f. Other Test Scores | 1= Yes 2= No |
38 | othspf2 | Specify | String[40] |
39 | othreas2 | 2g. Other Reason(s) | 1= Yes 2= No |
40 | othrspf2 | Specify | String[40] |
41 | memory1 | 3. Memory | 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe 6= Missing |
42 | opinion3 | 3a. Neuropsychologist's Opinion | 1= Agree 2= Disagree |
43 | implev3 | 3b. Level of Impairment | 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe 6= Unable to determine |
44 | educat3 | 3c. Reason(s) Education Adjustment | 1= Yes 2= No |
45 | eduspf3 | Specify | String[40] |
46 | sensor3 | 3d. Sensory Impairment | 1= Yes 2= No |
47 | senspf3 | Specify | String[40] |
48 | prcoop3 | 3e. Poor Cooperation | 1= Yes 2= No |
49 | poorspf3 | Specify | String[40] |
50 | othtest3 | 3f. Other Test Scores | 1= Yes 2= No |
51 | othspf3 | Specify | String[40] |
52 | othreas3 | 3g. Other Reason(s) | 1= Yes 2= No |
53 | othrspf3 | Specify | String[40] |
54 | lang | 4. Language | 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe 6= Missing |
55 | opinion4 | 4a. Neuropsychologist's Opinion | 1= Agree 2= Disagree |
56 | implev4 | 4b. Level of Impairment | 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe 6= Unable to determine |
57 | educat4 | 4c. Reason(s) Education Adjustment | 1= Yes 2= No |
58 | eduspf4 | Specify | String[40] |
59 | sensor4 | 4d. Sensory Impairment | 1= Yes 2= No |
60 | senspf4 | Specify | String[40] |
61 | prcoop4 | 4e. Poor Cooperation | 1= Yes 2= No |
62 | poorspf4 | Specify | String[40] |
63 | othtest4 | 4f. Other Test Scores | 1= Yes 2= No |
64 | othspf4 | Specify | String[40] |
65 | othreas4 | 4g. Other Reason(s) | 1= Yes 2= No |
66 | othrspf4 | Specify | String[40] |
67 | perceptn | 5. Perception | 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe 6= Missing |
68 | opinion5 | 5a. Neuropsychologist's Opinion | 1= Agree 2= Disagree |
69 | implev5 | 5b. Level of Impairment | 1= Normal 2= Possible 3= Mild 4= Moderate 5= Severe 6= Unable to determine |
70 | educat5 | 5c. Reason(s) Education Adjustment | 1= Yes 2= No |
71 | eduspf5 | Specify | String[40] |
72 | sensor5 | 5d. Sensory Impairment | 1= Yes 2= No |
73 | senspf5 | Specify | String[40] |
74 | prcoop5 | 5e. Poor Cooperation | 1= Yes 2= No |
75 | poorspf5 | Specify | String[40] |
76 | othtest5 | 5f. Other Test Scores | 1= Yes 2= No |
77 | othspf5 | Specify | String[40] |
78 | othreas5 | 5g. Other Reason(s) | 1= Yes 2= No |
79 | othrspf5 | Specify | String[40] |
80 | summary | SUMMARY-MAP NEUROPSYCHOLOGIST'S IMPRESSION for ^IntroBlock.projid; Date: ^IntroBlock.dateint Domain Algorithmic Dx Agree/Disagree Neuropsychologist's Dx Orientation ^cict.orient ^op1 ^scorient Attention ^cict.attentn ^op2 ^scATTENT Memory ^cict.memory1 ^op3 ^scMEMORY Language ^cict.lang ^op4 ^scLANGUA Perception ^cict.perceptn ^op5 ^scPERCEP Dementia ^dement1 Alzhiemer's ^alzhm1 Number of Impaired domains: ^scIMPDOM ^REQUIRES <<<<<END OF SUMMARY SCREEN<<<<< | |
81 | scorient | String[20] | |
82 | scattent | String[20] | |
83 | scmemory | String[20] | |
84 | sclangua | String[20] | |
85 | scpercep | String[20] | |
86 | scimpdom | 0 .. 5 | |
87 | dement | Dementia | 1= Highly Probable 2= Probable 3= Possible 4= Not Present |
88 | alzhm | Alzheimer's Disease | 1= Highly Probable 2= Probable 3= Possible 4= Not Present |
89 | autotm1 | [COMPUTER CLOCK TIME] | String[8] |
90 | comm | Diagnostic Impression/Comments | String[150] |
91 | 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 |
92 | formpart | Was participant reluctant, and/or does participant have special needs? | 1= Yes 2= No |
93 | formcomm | Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] | String[120] |
94 | statid | Please enter you staff id. | 100 .. 997 |
95 | formch | Has the form been modified? | 1= Yes 2= No |
96 | revidate | Enter the date that the form was modified. | Date type |
97 | revintd | Enter your staff id number. | 100 .. 997 |