Please rate the severity of your symptoms over the past 7 days, on average. The more severe and debilitating the symptom, slide right. If you're not having that symptom, slide to the left.
Slowness
* must provide value
Constipation (incomplete bowel emptying)
* must provide value
Walking
* must provide value
Freezing
* must provide value
Falling
* must provide value
Rising from Seated Position
* must provide value
Dressing, Eating, & Grooming
* must provide value
Motivation/ Initiative
* must provide value
Handwriting or Typing
* must provide value
Depression (feeling sad, blues)
* must provide value
Loss of Interest
* must provide value
Anxiety
* must provide value
Fatigue
* must provide value
Daytime Sleepiness
* must provide value
Dyskinesia
(rocking, writhing, twisting, squirming movements associated with medication.)
* must provide value
Tremor
* must provide value
How it has been, on average, over the past week
Balance
* must provide value
Control of Body Temperature
(symptoms may include cold hands and feet or sweating)
* must provide value
Dizzy on standing
* must provide value
Visual Disturbance
* must provide value
Insomnia
(Inability to sleep)
* must provide value
REM Sleep Behavior Disorder
(acting out dreams)
* must provide value
Restless Leg Syndrome
(urge to move legs in order to stop unpleasant sensations.)
* must provide value
Muscle cramping, pain, or aching
(most common in the morning or as medications wear off)
* must provide value
Speech
* must provide value
Drooling
* must provide value
Stooped posture
* must provide value
Memory/ Forgetfulness
* must provide value
Comprehension
* must provide value
Sense of smell
* must provide value
Medication Side Effects
* must provide value
on/ off, nausea, dyskinesia, etc.
Sexual Dysfunction
(loss of libido, erectile dysfunction, difficulty with orgasm)
* must provide value
Urinary symtpoms
(dribbling, urgency, incontinence)
* must provide value
Hallucinations or Delusions
(seeing things that aren't there)
* must provide value
Nausea
* must provide value
Do you have a diagnosis of Parkinson's disease?
* must provide value
No. I'm a healthy control.
PD suspected, not diagnosed.
I have something related to PD, but it's not PD.
I have a diagnosis of PD
Female Male
Do we have your permission to use your data for research?
* must provide value
Yes
No
Cumulative Score= Sum of all variables
(Each variable scored 0-100)
View equation
We are trying to eradicate PD and improve the lives of those currently affected.
Do we have your permission to contact you (via email) if there is an internet-based study for which you may be eligible?
Yes
No
Please contact lmischley@bastyr.edu for questions about using this scale.
Copyright Laurie K Mischley 2013
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