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eCRF compilation for new case
Part 3 - Clinical Features of PD & Investigations
Motor features
Year of assessment:
2020
2019
2018
Resting tremor:
no
yes
unknown
Postural tremor:
no
yes
unknown
Action tremor:
no
yes
unknown
Slow movements:
no
yes
unknown
Rigidity/ stiffness:
no
yes
unknown
Gait difficulty:
no
yes
unknown
Gait freezing:
no
yes
unknown
Postural instability/ Falls:
no
yes
unknown
Dystonia:
no
yes
unknown
Obvious asymmetry:
no
yes
unknown
Clear favourable response to dopaminergic medication:
no
yes
unknown
Motor fluctuations (ON/OFF periods related to timing of dopaminergic medications):
no
yes
unknown
Levodopa-induced dyskinesias:
no
yes
unknown
Sleep benefit:
no
yes
unknown
Upper motor neuron signs (hyperreflexia, plus extensor plantar response or sustained clonus)
no
yes
unknown
Other (please specify):
First motor symptom:
Tremor
Micrographia
Stiffness\ frozen shoulder
Non-motor features
RBD
no
yes
unknown
Insomnia
no
yes
unknown
Excessive daytime sleepiness
no
yes
unknown
Depression
no
yes
unknown
Anxiety
no
yes
unknown
Mild cognitive impairment
no
yes
unknown
Dementia
no
yes
unknown
Visual hallucinations
no
yes
unknown
Impulse control disorder
no
yes
unknown
Constipation
no
yes
unknown
Urinary dysfunction
no
yes
unknown
Orthostatic giddiness or hypotension
no
yes
unknown
Hyposmia
no
yes
unknown
Underweight
no
yes
unknown
Other (please specify):
PD rating scales: Please tick any that are available: (Please give the patient's latest assessments)
Hoehn & Yahr
Stage:
1
2
3
4
5
Year of assessment:
2020
2019
2018
UPDRS
Part III score
–
+
Part III score
ON-medication
OFF-medication
not specified
Year of assessment:
2020
2019
2018
Total score
–
+
Total score
ON-medication
OFF-medication
not specified
Year of assessment:
2020
2019
2018
MDS-UPDRS
Part III score
–
+
Part III score
–
+
Year of assessment:
2020
2019
2018
CISI-PD
Motor signs score:
–
+
Disability score:
–
+
Motor complications score:
–
+
Cognitive status score:
–
+
Total score:
–
+
Year of assessment:
2020
2019
2018
Part 3.2
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