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NON-MOTOR
1) Intellectual Impairment (Cognition)
None.
Mild. Consistent forgetfulness with partial recollection of events and no other difficulties.
Moderate memory loss, with disorientation and moderate difficulty handling complex problems. Mild but definite impairment of function at home with need of occasional prompting.
Severe memory loss with disorientation for time and often places. Severe impairment in handling problems.
Severe memory loss with orientation preserved to person only. Unable to make judgments or solve problems. Requires much help with personal care. Cannot be left alone at all.
2) Mood
Depression not present.
Periods of sadness or guilt greater than normal, never sustained for days or weeks.
Sustained depression for 1 week or more.
Sustained depression with vegetative symptoms of insomnia, anorexia, weight loss, loss of interest.
Sustained depression with vegetative symptoms and suicidal thoughts or intent.
MOTOR
3a) Rest tremor in RIGHT upper extremity
Absent.
Slight and infrequently present.
Mild in amplitude and persistent. Or moderate in amplitude, but only intermittently present.
Moderate in amplitude and present most of the time.
Marked in amplitude and present most of the time.
3b) Rest tremor in LEFT upper extremity
Absent.
Slight and infrequently present.
Mild in amplitude and persistent. Or moderate in amplitude, but only intermittently present.
Moderate in amplitude and present most of the time.
Marked in amplitude and present most of the time.
4a) Finger taps in RIGHT upper extremity (Patient taps thumb with index finger in rapid succession with widest amplitude possible, each hand separately)
Normal.
Mild slowing and/or reduction in amplitude.
Moderately impaired. Definite and early fatiguing. May have occasional arrests in movement.
Severely impaired. Frequent hesitation in initiating movements or arrests in ongoing movement.
Can barely perform task.
4b) Finger taps in LEFT upper extremity (Patient taps thumb with index finger in rapid succession with widest amplitude possible, each hand separately)
Normal.
Mild slowing and/or reduction in amplitude.
Moderately impaired. Definite and early fatiguing. May have occasional arrests in movement.
Severely impaired. Frequent hesitation in initiating movements or arrests in ongoing movement.
Can barely perform task.
5) Gait
Normal.
Walks slowly, may shuffle with short steps, but no festination (hastening steps) or propulsion.
Walks with difficulty, but requires little or no assistance; may have some festination, short steps, or propulsion.
Severe disturbance of gait, requiring assistance.
Cannot walk at all, even with assistance.
MOTOR COMPLICATIONS (In the past week)
6) Off-time: What proportion of the waking day is the patient “off” on average?
None.
1-25% of day.
26-50% of day.
51-75% of day.
76-100% of day.
7) Dyskinesia duration: What proportion of the waking day are dyskinesias present?
None.
1-25% of day.
26-50% of day.
51-75% of day.
76-100% of day.
8) Dyskinesia disability: How disabling are the dyskinesias?
Not disabling.
Mildly disabling.
Moderately disabling.
Severely disabling.
Completely disabling.
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