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eCRF compilation for new case
Part 2 - Genotyping & Family History
Year of sample collection:
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
Genotyping done?
no
yes, and not found to have any likely pathogenic mutation related to PD
Please give detailed description of positive findings (including details at cDNA and protein level, and zygosity, e.g., LRRK2, c.6055G>A, p.G2019, heterozygous):
LRRK2
SNCA
VPS35
PINK1
Family member(s) with PD (Have any members of your immediate or Extended family been diagnosed with Parkinsons by a doctor?):
yes
no
Other family member(s) with symptoms suggestive of PD (Are there any other family members with symptoms or signs suggestive of Parkinsons?):
no
yes, number of relatives with symptoms but not diagnosed with PD:
Please list:
Relationship to index case:
Year of birth:
Year of symptom onset:
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
Genetic diagnosis achieved:
no
yes (same as index case)
yes (different from index)
Genetic diagnosis achieved:
not available
no, but contactable
yes
Family members with other neurological disorders ("Have any members of your immediate or extended family been diagnosed with neurological disorders other than Parkinson's, such as a Parkinson-plus syndrome, dementia, motor neuron disease, cerebellar ataxia, dystonia, spastic paraplegia, epilepsy, or intellectual disability?"):
no
yes
Fathers father:
American Indian/ Alaska Native
Arab
Asian
White/ Caucasian/ European:
Country where fathers father has lived most of his life:
Afghanistan
Albania
Algeria
Fathers mother:
American Indian/ Alaska Native
Arab
Asian
White/ Caucasian/ European:
Country where fathers mother has lived most of her life:
Afghanistan
Albania
Algeria
Mothers father:
American Indian/ Alaska Native
Arab
Asian
White/ Caucasian/ European:
Country where mothers father has lived most of his life:
Afghanistan
Albania
Algeria
Mothers mother:
American Indian/ Alaska Native
Arab
Asian
White/ Caucasian/ European:
Country where mothers mother has lived most of her life:
Afghanistan
Albania
Algeria
Part 3
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