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Monogenic Hub
eCRF compilation for new case
Part 3 - Clinical Features of PD & Investigations
Motor features
Year of assessment:
Resting tremor:
Postural tremor:
Action tremor:
Slow movements:
Rigidity/ stiffness:
Gait difficulty:
Gait freezing:
Postural instability/ Falls:
Dystonia:
Obvious asymmetry:
Clear favourable response to dopaminergic medication:
Motor fluctuations (ON/OFF periods related to timing of dopaminergic medications):
Levodopa-induced dyskinesias:
Sleep benefit:
Upper motor neuron signs (hyperreflexia, plus extensor plantar response or sustained clonus)
Other (please specify):
First motor symptom:
Non-motor features
RBD
Insomnia
Excessive daytime sleepiness
Depression
Anxiety
Mild cognitive impairment
Dementia
Visual hallucinations
Impulse control disorder
Constipation
Urinary dysfunction
Orthostatic giddiness or hypotension
Hyposmia
Underweight
Other (please specify):
PD rating scales: Please tick any that are available: (Please give the patient's latest assessments)
Hoehn & Yahr
Stage:
Year of assessment:
UPDRS
Part III score
– +
Part III score
Year of assessment:
Total score
– +
Total score
Year of assessment:
MDS-UPDRS
Part III score
– +
Part III score
– +
Year of assessment:
CISI-PD
Motor signs score:
– +
Disability score:
– +
Motor complications score:
– +
Cognitive status score:
– +
Total score:
– +
Year of assessment:
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