Data Dictionary for mp2cev
Number of Blaise fields: 645
| Seq # | Var | Question | Data Type/Coding |
|---|---|---|---|
| 1 | projid | MAP 2001 BASELINE Clinical Evaluation (Version: 01/30/2026) 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 | 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 |
| 320 | strokeyr | 1a. When was the last time? [ENTER YEAR] [INTERVIEWER: `Last' refers to the most recent event.] | 1940 .. 2030 |
| 321 | 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 |
| 322 | dizzy0 | b. Dizzyness or lightheadedness? | 1= Yes 2= Suspect 3= No |
| 323 | memory0 | c. Memory loss or forgetfulness? | 1= Yes 2= Suspect 3= No |
| 324 | speech0 | At the time of this (last) event, did you you have . . . d. Language or speech change? | 1= Yes 2= Suspect 3= No |
| 325 | vision0 | e. Loss of vision? | 1= No 2= right only 3= left only 4= both |
| 326 | face0 | f. Weakness or paralysis of your face? | 1= No 2= right only 3= left only 4= both |
| 327 | weaklim0 | g. Weakness or paralysis of your arms or legs? | 1= No 2= right only 3= left only 4= both |
| 328 | limsens0 | h. Loss or change of sensation in your arms or legs? | 1= No 2= right only 3= left only 4= both |
| 329 | imbal0 | i. Imbalance or difficulty in walking? | 1= Yes 2= Suspect 3= No |
| 330 | sympspe0 | j. Specify any other signs or symptoms associated with this (last) event? | String[40] |
| 331 | 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 |
| 332 | samespe0 | Specify: | String[60] |
| 333 | 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 |
| 334 | prompt1 | 2a. Was this the same event we just spoke about? | 1= Yes 2= No |
| 335 | hospyear | When was the last time? [ENTER YEAR] [INTERVIEWER: `Last' refers to the most recent hospitalization event.] | 1940 .. 2030 |
| 336 | hospname | 2b. What was the name of the hospital? | String[30] |
| 337 | 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 |
| 338 | dizzy1 | b. Dizzyness or lightheadedness? | 1= Yes 2= Suspect 3= No |
| 339 | memory1 | c. Memory loss or forgetfulness? | 1= Yes 2= Suspect 3= No |
| 340 | 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 |
| 341 | vision1 | e. Loss of vision? | 1= No 2= right only 3= left only 4= both |
| 342 | face1 | f. Weakness or paralysis of your face? | 1= No 2= right only 3= left only 4= both |
| 343 | weaklim1 | g. Weakness or paralysis of your arms or legs? | 1= No 2= right only 3= left only 4= both |
| 344 | limsens1 | h. Loss or change of sensation in your arms or legs? | 1= No 2= right only 3= left only 4= both |
| 345 | sympspe1 | i. Specify any other signs or symptoms associated with this (last) event? | String[40] |
| 346 | 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 |
| 347 | samespe1 | Specify: | String[60] |
| 348 | 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 |
| 349 | prompt2 | 3a. Was this for ^event we just spoke about? | 1= Yes 2= No |
| 350 | scanyear | When was the last time? [ENTER YEAR] [INTERVIEWER: `Last' refers to the most recent scan.] | 1940 .. 2030 |
| 351 | scanloc | 3b. What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? | String[30] |
| 352 | 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 |
| 353 | dizzy2 | b. Dizzyness or lightheadedness? | 1= Yes 2= Suspect 3= No |
| 354 | memory2 | c. Memory loss or forgetfulness? | 1= Yes 2= Suspect 3= No |
| 355 | speech2 | d. Language or speech change? | 1= Yes 2= Suspect 3= No |
| 356 | vision2 | e. Loss of vision? | 1= No 2= right only 3= left only 4= both |
| 357 | face2 | f. Weakness or paralysis of your face? | 1= No 2= right only 3= left only 4= both |
| 358 | weaklim2 | g. Weakness or paralysis of your arms or legs? | 1= No 2= right only 3= left only 4= both |
| 359 | limsens2 | h. Loss or change of sensation in your arms or legs? | 1= No 2= right only 3= left only 4= both |
| 360 | sympspe2 | i. Specify any other signs or symptoms associated with this (last) event? | String[40] |
| 361 | 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 |
| 362 | samespe2 | Specify: | String[60] |
| 363 | multiple | 4. Did you have only ONE STROKE, TIA or BRAIN HEMORRHAGE, or more than one? | 1= Only one 2= More than one |
| 364 | leftspec | 5. Specify leftover troubles from your stroke(s)? | String[60] |
| 365 | everscan | 6. Have you EVER had a CT, MRI or other type of brain scan? | 1= Yes 2= Suspect 3= No |
| 366 | reason | 6c. Reason | String[60] |
| 367 | escanloc | 6d. What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? | String[30] |
| 368 | speech0dur | How long did the language or speech change last? | 1= Less than 1 hour 2= 1 to 24 hours 3= More than 24 hours |
| 369 | vision0dur | How long did the loss of vision last? | 1= Less than 1 hour 2= 1 to 24 hours 3= More than 24 hours |
| 370 | face0dur | How long did the weakness or paralysis of your face last? | 1= Less than 1 hour 2= 1 to 24 hours 3= More than 24 hours |
| 371 | weaklim0dur | How long did the weakness or paralysis of your arms or legs last? | 1= Less than 1 hour 2= 1 to 24 hours 3= More than 24 hours |
| 372 | limsens0dur | How long did the loss or change of sensation in your arms or legs last? | 1= Less than 1 hour 2= 1 to 24 hours 3= More than 24 hours |
| 373 | imbal0dur | How long did the imbalance or difficulty walking last? | 1= Less than 1 hour 2= 1 to 24 hours 3= More than 24 hours |
| 374 | symspe0dur | How long did the other symptoms last? | 1= Less than 1 hour 2= 1 to 24 hours 3= More than 24 hours |
| 375 | 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 |
| 376 | year | 1a. When were you first told this? | 1940 .. 2030 |
| 377 | gait | With the parkinsonism, did you have . . . 2. Shuffling or unsteady gait, or loss of balance? | 1= Yes 2= Suspect 3= No |
| 378 | writing | 3. A change in your handwriting? | 1= Yes 2= Suspect 3= No |
| 379 | stiff | 4. Stiffness or rigidity of your arms or legs? | 1= No 2= right only 3= left only 4= both |
| 380 | slowmove | 5. Slowness of movement of your arms, hands or legs? | 1= No 2= right only 3= left only 4= both |
| 381 | tremor | 6. Tremor of your hands or feet? | 1= No 2= right only 3= left only 4= both |
| 382 | 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 |
| 383 | medspec | 7a. Specify | String[30] |
| 384 | histad | Have you ever been told by a doctor, nurse, or therapist that you had dementia, senility, or Alzheimer's disease? | 1= Yes 2= Suspect 3= No |
| 385 | respqs | Will MEP/MIP data be entered directly into Blaise form? | 1= Yes 2= No |
| 386 | 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 |
| 387 | expir2 | [Reset to 0. Enter 995.5 for tried, but unable.] MEP trial 2 ________ cm H20 | 1.0 .. 995.5 |
| 388 | 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 |
| 389 | inspir2 | [Reset to 0. Enter 995.5 for tried, but unable.] MIP trial 2 ________ cm H20 | 1.0 .. 995.5 |
| 390 | mepmipcm | MEP/MIP Enter any comments. [Press enter to continue if none.] | String[250] |
| 391 | spiroqs | Will spirometry data be entered directly into Blaise form? | 1= Yes 2= No |
| 392 | fev11 | RESET Spirometry device FEV1 Trial 1 [Enter 95.5 for tried but unable.] _____ liters | 0.00 .. 95.50 |
| 393 | pvc1 | PVC Trial 1 _____ liters | 0.00 .. 10.00 |
| 394 | fer1 | FER Trial 1 _____ percent | 0 .. 100 |
| 395 | pef1 | PEF Trial 1 _____ liters/minute [If greater than 999, enter 999.] | 0 .. 999 |
| 396 | fev12 | RESET Spirometry device FEV1 Trial 2 [Enter 95.5 for tried but unable.] _____ liters | 0.00 .. 95.50 |
| 397 | pvc2 | PVC Trial 2 _____ liters | 0.00 .. 10.00 |
| 398 | fer2 | FER Trial 2 _____ percent | 0 .. 100 |
| 399 | pef2 | PEF Trial 2 _____ liters/minute [If greater than 999, enter 999.] | 0 .. 999 |
| 400 | spcom | Spirometry Enter any comment. [Press enter to continue if none.] | String[250] |
| 401 | 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 |
| 402 | q8ana | Specify reason. | String[40] |
| 403 | 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 |
| 404 | q8bna | Specify reason. | String[40] |
| 405 | 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 |
| 406 | q8cna | Specify reason. | String[40] |
| 407 | 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 |
| 408 | q8dna | Specify reason. | String[40] |
| 409 | 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 |
| 410 | rhand1na | Specify reason. | String[40] |
| 411 | 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 |
| 412 | lhand1na | Specify reason. | String[40] |
| 413 | 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 |
| 414 | rhand2na | Specify reason. | String[40] |
| 415 | 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 |
| 416 | lhand2na | Specify reason. | String[40] |
| 417 | 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 |
| 418 | rthand1n | Specify reason. | String[40] |
| 419 | 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 |
| 420 | lthand1n | Specify reason. | String[40] |
| 421 | 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 |
| 422 | rthand2n | Specify reason. | String[40] |
| 423 | 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 |
| 424 | lthand2n | Specify reason. | String[40] |
| 425 | 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 |
| 426 | fissures | 2. Palpebral fissures | 1= Symmetric 2= Right wider than left 3= Left wider than right 7= Unable to test |
| 427 | 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 |
| 428 | rightinf | 2. Right inferior quadrant | 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test |
| 429 | leftsup | 3. Left superior quadrant | 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test |
| 430 | leftinf | 4. Left inferior quadrant | 1= No visual field defect 2= Possible visual field defect 3= Definite visual field defect 7= Unable to test |
| 431 | 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 |
| 432 | 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 |
| 433 | 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 |
| 434 | 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 |
| 435 | 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 |
| 436 | 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 |
| 437 | lhanddys | 2. Left hand | 1= No dysmetria 2= Possible dysmetria 3= Definite dysmetria 4= Unable to assess due to weakness 7= Unable to test |
| 438 | 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 |
| 439 | rhamp | 3a. Amplitude | 1= Slight 2= Mild 3= Moderate 4= Marked |
| 440 | rhaorp | 3b. Posture/Action | 1= Action only 2= Posture only 3= Action AND posture |
| 441 | rhfreq | 3c. Frequency | 1= Slow [<7 Hz] 2= Moderate [7-10 Hz] 3= Fast [>10 Hz] |
| 442 | lhandact | 4. Left hand | 1= Absent 2= Possible 3= Present 4= Unable to test due to weakness |
| 443 | lhamp | 4a. Amplitude | 1= Slight 2= Mild 3= Moderate 4= Marked |
| 444 | lhaorp | 4b. Posture/Action | 1= Action only 2= Posture only 3= Action AND posture |
| 445 | lhfreq | 4c. Frequency | 1= Slow [<7 Hz] 2= Moderate [7-10 Hz] 3= Fast [>10 Hz] |
| 446 | scptrem | 0 .. 8 | |
| 447 | scrtrem | 0 .. 30 | |
| 448 | ilptrem | String[6] | |
| 449 | ilrtrem | String[6] | |
| 450 | mposttrm | 0 .. 2 | |
| 451 | mresttrm | 0 .. 5 | |
| 452 | 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] |
| 453 | 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. |
| 454 | 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. |
| 455 | 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. |
| 456 | 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. |
| 457 | 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. |
| 458 | 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. |
| 459 | 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. |
| 460 | 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. |
| 461 | scbrady | 0 .. 70 | |
| 462 | ilbrady | String[6] | |
| 463 | mbrady | 0 .. 8 | |
| 464 | 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 |
| 465 | 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 |
| 466 | armsym | 3. Arm drift symmetric | 1= Yes 2= Right weaker than left 3= Left weaker than right 7= Unable to test |
| 467 | 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 |
| 468 | neckcog | 1a. Cogwheeling | 1= Yes 2= Suspect 3= No 7= Unable to test |
| 469 | 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 |
| 470 | rarmcog | 2a. Cogwheeling | 1= Yes 2= Suspect 3= No 7= Unable to test |
| 471 | rarmspas | 3. Spasticity. | 1= Yes 2= Suspect 3= No 7= Unable to test |
| 472 | 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 |
| 473 | larmcog | 5a. Cogwheeling | 1= Yes 2= Suspect 3= No 7= Unable to test |
| 474 | larmspas | 6. Spasticity. | 1= Yes 2= Suspect 3= No 7= Unable to test |
| 475 | 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 |
| 476 | rlegcog | 8a. Cogwheeling | 1= Yes 2= Suspect 3= No 7= Unable to test |
| 477 | rlegspas | 9. Spasticity. | 1= Yes 2= Suspect 3= No 7= Unable to test |
| 478 | 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 |
| 479 | llegcog | 11a. Cogwheeling | 1= Yes 2= Suspect 3= No 7= Unable to test |
| 480 | llegspas | 12. Spasticity. | 1= Yes 2= Suspect 3= No 7= Unable to test |
| 481 | scrigid | 0 .. 25 | |
| 482 | ilrigid | String[6] | |
| 483 | mrigid | 0 .. 5 | |
| 484 | 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 |
| 485 | lbiceps | 2. Left Biceps | 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test |
| 486 | bicepsym | 3. Biceps symmetric | 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test |
| 487 | rtriceps | 7. Right Triceps | 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test |
| 488 | ltriceps | 8. Left Triceps | 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test |
| 489 | tricpsym | 9. Triceps symmetric | 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test |
| 490 | rpatella | 10. Right Patella | 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test |
| 491 | lpatella | 11. Left Patella | 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test |
| 492 | patelsym | 12. Patella symmetric | 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test |
| 493 | rachill | 13. Right achilles | 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test |
| 494 | lachill | 14. Left achilles | 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 5= Possibly increased 6= Definitely increased 7= Unable to test |
| 495 | achilsym | 15. Achilles symmetric | 1= Yes 2= Right greater than left 3= Left greater than right 7= Unable to test |
| 496 | rbigtoe | BABINSKI SIGN 1. Right big toe | 1= Normal 2= Possible 3= Present 7= Unable to test |
| 497 | lbigtoe | 2. Left big toe | 1= Normal 2= Possible 3= Present 7= Unable to test |
| 498 | bmd1 | Clinical Bone Sonometer Bone Mineral Density (BMD) Trial 1 _____ g/cm2 [Enter 7 for tried but unable.] | 0.000 .. 7.000 |
| 499 | tscore1 | Trial 1 Record T score ______ | -5.0 .. 4.0 |
| 500 | qui1 | Trial 1 Record Quality Ultrasound Index (QUI)/stiffness _____ | -50.0 .. 200.0 |
| 501 | bua1 | Trial 1 Record broad band ultrasound attenuation (BUA) _____dB/MHz | 0.0 .. 200.0 |
| 502 | sos1 | Trial 1 Record speed of sound (SOS) _____ m/sec | 800.0 .. 2500.0 |
| 503 | 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] |
| 504 | 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 |
| 505 | ltoevib | Vibratory sensation 2. Left big toe | 1= Normal 2= Possibly reduced 3= Definitely reduced 4= Absent 7= Unable to test |
| 506 | 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 |
| 507 | 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 |
| 508 | 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 |
| 509 | 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 |
| 510 | 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 |
| 511 | 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 |
| 512 | 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 |
| 513 | ltlegpin | Stocking pattern of pin loss 6. Left leg. | 1= Yes 2= Possible 3= No |
| 514 | 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 |
| 515 | larmabd1 | 2. Left arm abduction [DELTOID] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 516 | rarmabd2 | 3. Right arm abduction [DELTOID] Trial 2 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 517 | larmabd2 | 4. Left arm abduction [DELTOID] Trial 2 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 518 | rarmflx1 | Right arm flexion [BICEPS] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 519 | larmflx1 | Left arm flexion [BICEPS] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 520 | rarmext1 | Right arm extension [TRICEPS] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 521 | larmext1 | Left arm extension [TRICEPS] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 522 | rhipflx1 | 5. Right hip flexion [ILIOPSOAS] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 523 | lhipflx1 | 6. Left hip flexion [ILIOPSOAS] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 524 | rhipflx2 | 7. Right hip flexion [ILIOPSOAS] Trial 2 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 525 | lhipflx2 | 8. Left hip flexion [ILIOPSOAS] Trial 2 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 526 | rlegext1 | 9. Right leg extension [QUADRICEPS] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 527 | llegext1 | 10. Left leg extension [QUADRICEPS] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 528 | rfotflx1 | 13. Right foot plantar flexion [GASTROCNEMIUS] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 529 | lfotflx1 | 14. Left foot plantar flexion [GASTROCNEMIUS] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 530 | rfotflx2 | 15. Right foot plantar flexion [GASTROCNEMIUS] Trial 2 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 531 | lfotflx2 | 16. Left foot plantar flexion [GASTROCNEMIUS] Trial 2 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 532 | rfotdor1 | Right foot dorsiflexion [TIBIALIS ANTERIOR] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 533 | lfotdor1 | Left foot dorsiflexion [TIBIALIS ANTERIOR] Trial 1 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 534 | rfotdor2 | Right foot dorsiflexion [TIBIALIS ANTERIOR] Trial 2 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 535 | lfotdor2 | Left foot dorsiflexion [TIBIALIS ANTERIOR] Trial 2 - Enter 95.5 for tried, but unable | 0.1 .. 95.5 |
| 536 | musclst201 | 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 |
| 537 | musclst202 | 17. List all muscles you were unable to break | See previous question |
| 538 | musclst203 | 17. List all muscles you were unable to break | See previous question |
| 539 | musclst204 | 17. List all muscles you were unable to break | See previous question |
| 540 | musclst205 | 17. List all muscles you were unable to break | See previous question |
| 541 | musclst206 | 17. List all muscles you were unable to break | See previous question |
| 542 | musclst207 | 17. List all muscles you were unable to break | See previous question |
| 543 | musclst208 | 17. List all muscles you were unable to break | See previous question |
| 544 | musclst209 | 17. List all muscles you were unable to break | See previous question |
| 545 | musclst210 | 17. List all muscles you were unable to break | See previous question |
| 546 | musclst211 | 17. List all muscles you were unable to break | See previous question |
| 547 | musclst212 | 17. List all muscles you were unable to break | See previous question |
| 548 | musclst213 | 17. List all muscles you were unable to break | See previous question |
| 549 | musclst214 | 17. List all muscles you were unable to break | See previous question |
| 550 | mmtcom | Nicholas MMT Enter any comments. [Press enter to continue if none.] | String[250] |
| 551 | 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 |
| 552 | 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 |
| 553 | 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 |
| 554 | armswing | 3a. Reduced Armswing | 1= Yes 2= Suspect 3= No 7= Unable to test |
| 555 | armside | 3b. On which side is the armswing reduced? | 1= Right 2= Left 3= Both |
| 556 | legcirc | 4. Circumduction of Leg | 1= Yes 2= Suspect 3= No 7= Unable to test |
| 557 | legside | 4a. On which side is this? | 1= Right 2= Left 3= Both |
| 558 | 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 |
| 559 | 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 |
| 560 | gaitspec | 10. Other gait abnormality [Press enter to continue if none.] | String[40] |
| 561 | 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 |
| 562 | 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] |
| 563 | 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 |
| 564 | numsteps | 2a. NUMBER OF STEPS | 3 .. 20 |
| 565 | pull | 2b. Strength of pull | 1= Very light pull 2= Mild to moderate pull 3= Moderate to strong pull 4= Strong pull |
| 566 | screflex | 0 .. 35 | |
| 567 | ilreflex | String[6] | |
| 568 | mreflex | 0 .. 6 | |
| 569 | 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] |
| 570 | bedtime_ampm | 1. During the past month, when have you usually gone to bed at night? 1a. [am/pm] | String[2] |
| 571 | min2sleep | 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 |
| 572 | getuptime | 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] |
| 573 | getuptime_ampm | 3. During the past month, when have you usually gotten up in the morning? 3a. [am/pm] | String[2] |
| 574 | 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 |
| 575 | sleephrs_min | 4. During the past month, how many hours did you usually sleep at night? 4a. [minutes] | 0 .. 59 |
| 576 | trsleep_freq | 5. How often do you have trouble falling asleep? | 1= Never 2= Rarely 3= Sometimes 4= Often 5= Very often |
| 577 | trsleep30min_freq | 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 |
| 578 | wakenight_freq | 7. How often are you troubled by waking up during the night? | 1= Never 2= Rarely 3= Sometimes 4= Often 5= Very often |
| 579 | wakenightmorning_freq | 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 |
| 580 | rested_freq | 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 |
| 581 | tiredaftersleep_freq | 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 |
| 582 | tiredwake_freq | 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 |
| 583 | 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 |
| 584 | sleepdriving | 13. Have you ever nodded off or fallen asleep while driving a vehicle? | 0= No 1= Yes |
| 585 | sleepdriving_freq | 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 |
| 586 | psqi_medication | 14. Have you used sleeping medications in two weeks prior to this interview? | 0= No 1= Yes |
| 587 | snore | 15. Do you snore? | 0= No 1= Yes 9= Don't know |
| 588 | snorebother | 15a. Has your snoring ever bothered other people? | 0= No 1= Yes 9= Don't know |
| 589 | snorerating | 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 |
| 590 | snore_freq | 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 |
| 591 | breathpause_freq | 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 |
| 592 | sleepapnea | 17. Are you currently being treated for sleep apnea (e.g. CPAP)? | 0= No 1= Yes |
| 593 | 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 |
| 594 | actdream_years | 18a. How many months or years has this been going on? [Years] | 0 .. 99 |
| 595 | actdream_months | 18a. How many months or years has this been going on? [Months] 18a-1. [Months] | 0 .. 11 |
| 596 | actdream_injured | 18b. Have you ever been injured from these behaviors (bruises, cuts, broken bones)? | 0= No 1= Yes |
| 597 | actdream_injured_part | 18c. Has your bed-partner ever been injured from these behaviors (bruises, blows, pulled hair)? | 0= No 1= Yes |
| 598 | dreamattacked | 18d. Have you ever had dreams about being attacked, or that involved defending yourself? | 0= No 1= Yes |
| 599 | movdreammatched | 18e. Have you ever been told that the movements you made matched the details of your dream? | 0= No 1= Yes |
| 600 | sleepwalk | 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 |
| 601 | sleepwalk_freq | 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 |
| 602 | legtwitched | 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 |
| 603 | legdisrupt | 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 |
| 604 | legdisrupt_walk | 21a. Do these leg sensations decrease when you walk around? | 0= No 1= Yes |
| 605 | legdisrupt_worst | 21b. When do these sensations seem to be the worst? | 1= Before 6pm 2= After 6pm |
| 606 | 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 |
| 607 | 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 |
| 608 | cov1b | Revised COVID FORM 2022 1b. When did your first COVID-19 infection begin (month/year)? [ 88/8888 = Decline to answer ] | String[7] |
| 609 | 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) |
| 610 | 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 |
| 611 | 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 |
| 612 | 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 |
| 613 | 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 |
| 614 | 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 |
| 615 | 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 |
| 616 | ivisit | visit | |
| 617 | 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 |
| 618 | 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] |
| 619 | bp2 | 7. SECOND SITTING BLOOD PRESSURE READING [INTERVIEWER: ENTER SYSTOLIC/DIASTOLIC] | String[7] |
| 620 | 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] |
| 621 | 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 |
| 622 | hearimp | 2. Does the participant have a SUBSTANTIAL hearing impairment? | 1= Yes 2= No |
| 623 | 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 |
| 624 | 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 |
| 625 | comm | Comments. | String[120] |
| 626 | autotm1 | [COMPUTER CLOCK TIME] | String[8] |
| 627 | 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 <<<<< | |
| 628 | 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 <<<<< | |
| 629 | 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 | |
| 630 | 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 <<<<< | |
| 631 | 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 <<<<< | |
| 632 | 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 | |
| 633 | 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 >>>>> PRESS ENTER FOR NEXT SUMMARY SCREEN <<<<< | |
| 634 | 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 <<<<< | |
| 635 | 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 <<<<< | |
| 636 | 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 <<<<< | |
| 637 | 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 <<<<< | |
| 638 | report10 | NEURO EXAM-FOCAL SIGNS: SUBJECT ^intro.projid Date: ^intro.dateint SUMM PG 10/10 CEREBELLAR FUNCTION FINGER-TO-FINGER: ^normal1 ^a1^a2 GAIT: ^normal3^a5 ^a6^a7 >>>>> END OF SUMMARY SECTION <<<< | |
| 639 | 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 |
| 640 | formpart | Was participant reluctant, and/or does participant have special needs? | 1= Yes 2= No |
| 641 | formcomm | Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] | String[120] |
| 642 | statid | Please enter you staff id. | 100 .. 997 |
| 643 | formch | Has the form been modified? | 1= Yes 2= No |
| 644 | revidate | Enter the date that the form was modified. | Date type |
| 645 | revintd | Enter your staff id number. | 100 .. 997 |