eCRF compilation for new case
Part 3 - Clinical Features of PD & Investigations
PDQ-39
Total score:
Year of assessment:
NMSQ
Total score:
+
Year of assessment:
MMSE
Total score:
+
Year of assessment:
SCOPA-AUT
Total score:
+
Year of assessment:
Investigations
Brain CT
Year of most recent study
Result
Brain MRI
Year of most recent study
Result
DAT scan/ PET
Year of most recent study
Result
Transcranial sonography
Year of most recent study
Result
Smell testing (e.g., UPSIT, Sniffin Sticks - please specify)
Year of most recent study
Result
Polysomnography for RBD
Year of most recent study
Result
Myocardial MIBG scintigraphy
Year of most recent study
Result
Other (please specify):
Year of most recent study
Result
Treatment of PD
Year of assessment (if possible, please use the same assessment year as when the UPDRS/MDS-UPDRS was administered):
PD medications
Levodopa
COMT inhibitor (entacapone or opicapone)
Dopamine agonist (e.g., pramipexole, ropinirole, piribedil, rotigotine)
MAO-B inhibitor (selegiline, rasagiline)
Anticholinergic (e.g., benzhexol, trihexyphenidyl)
Amantadine
Levodopa-equivalent daily dosage (LEDD): (Please use the LEDD calculator provided)
Device-aided therapies for PD:
Functional neurosurgery
Year of surgery:
Apomorphine infusion
Year commenced:
Levodopa-carbidopa intestinal gel
Year commenced:
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