VIARTIS

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PARKINSON'S DISEASE

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5. FACIAL EXPRESSION

Which of the following best describes your facial expression ?

0 - Normal

1 - Minimal loss of facial expression

2 - Slight but definitely abnormal reduction in facial expression

3 - Moderate loss of facial expression. Lips frequently parted

4 - Severe or complete loss of facial expression. Lips usually significantly parted

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6. EYE MOVEMENT

Which of the following best describes the movement of your eyes?

0 - Normal

1 - Slight reduction in eye movement and blinking

2 - Distinct reduction in eye movement and blinking

3 - Frequent staring appearance of the eyes

4 - Almost continuous staring appearance of the eyes

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7. SENSE OF SMELL

Which of the following best describes your sense of smell ?

0 - Normal

1 - Distinctly reduced ability to smell

2 - Unable to smell anything without inhaling

3 - Unable to smell anything, unless inhaling strongly

4 - Unable to smell anything, despite inhaling strongly

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8. JAW TREMOR

Which of the following best describes the amount of jaw tremor ?

0 - No tremor

1 - Slight and infrequent tremor

2 - Moderate tremor that is intermittent

3 - Moderate tremor that is intermittent.

4 - Moderate tremor that is present most of the time.

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9. NECK RIGIDITY

Which of the following best describes the amount of rigidity when moving the neck ?

0 - No rigidity

1 - Slight or detectable rigidity

2 - Mild to moderate rigidity

3 - Marked rigidity, but with a full range of motion easily achieved

4 - Severe rigidity. A range of motion is only achieved with difficulty

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10. RIGHT ARM TREMOR AT REST

Which of the following best describes the right arm at rest ?

0 - Normal

1 - Slight and infrequent tremor

2 - Moderate tremor that is intermittent

3 - Moderate tremor that is present most of the time

4 - Severe tremor that is present most of the time

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11. LEFT ARM TREMOR AT REST

Which of the following best describes the left arm at rest ?

0 - Normal

1 - Slight and infrequent tremor

2 - Moderate tremor that is intermittent

3 - Moderate tremor that is present most of the time

4 - Severe tremor that is present most of the time

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12. RIGHT ARM ACTION TREMOR

Which of the following best describes the right arm whilst being used ?

0 - Normal

1 - Slight and infrequent tremor

2 - Moderate tremor that is intermittent

3 - Moderate tremor that is present most of the time

4 - Severe tremor that is present most of the time

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13. LEFT ARM ACTION TREMOR

Which of the following best describes the left arm whilst being used ?

0 - Normal

1 - Slight and infrequent tremor

2 - Moderate tremor that is intermittent

3 - Moderate tremor that is present most of the time

4 - Severe tremor that is present most of the time

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14. RIGHT HAND RIGIDITY

Which of the following best describes the amount of rigidity when moving the arms ?

0 - No rigidity

1 - Slight or detectable rigidity

2 - Mild to moderate rigidity

3 - Marked rigidity, but with a full range of motion easily achieved

4 - Severe rigidity. A range of motion is only achieved with difficulty

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15. LEFT HAND RIGIDITY

Which of the following best describes the amount of rigidity when moving the arms ?

0 - No rigidity

1 - Slight or detectable rigidity

2 - Mild to moderate rigidity

3 - Marked rigidity, but with a full range of motion easily achieved

4 - Severe rigidity. A range of motion is only achieved with difficulty

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16. RIGHT HAND TREMOR

Which of the following best describes the amount of tremor in the right hand ?

0 - No tremor

1 - Slight and infrequent tremor

2 - Moderate tremor that is intermittent

3 - Moderate tremor that is present most of the time

4 - Severe tremor that is present most of the time

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17. LEFT HAND TREMOR

Which of the following best describes the amount of tremor in the left hand ?

0 - No tremor

1 - Slight and infrequent tremor

2 - Moderate tremor that is intermittent

3 - Moderate tremor that is present most of the time

4 - Severe tremor that is present most of the time

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18. RIGHT HAND FINGER RIGIDITY

Which of the following best describes the fingers of the right hand when they tap on a surface ?

0 - Normal

1 - Mild slowing or reduction in magnitude

2 - Moderately impaired. Definite and early fatiguing. Occasionally ceases movement

3 - Severely impaired. Frequent hesitation or cessation of movement

4 - Can barely perform the task

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19. LEFT HAND FINGER RIGIDITY

Which of the following best describes the fingers of the right hand when they tap on a surface ?

0 - Normal

1 - Mild slowing or reduction in magnitude

2 - Moderately impaired. Definite and early fatiguing. Occasionally ceases movement

3 - Severely impaired. Frequent hesitation or cessation of movement

4 - Can barely perform the task

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20. RIGHT HAND RIGIDITY

Which of the following best describes what happens when you open and close your right hand in rapid succession ?

0 - Normal

1 - Mild slowing or reduction in magnitude

2 - Moderately impaired. Definite and early fatiguing. Occasionally ceases movement

3 - Severely impaired. Frequent hesitation or cessation of movement

4 - Can barely perform the task

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21. LEFT HAND RIGIDITY

Which of the following best describes what happens when you open and close your left hand in rapid succession ?

0 - Normal

1 - Mild slowing or reduction in magnitude

2 - Moderately impaired. Definite and early fatiguing. Occasionally ceases movement

3 - Severely impaired. Frequent hesitation or cessation of movement

4 - Can barely perform the task

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22. RIGHT LEG TREMOR

Which of the following best describes the amount of tremor in the right leg ?

0 - No tremor

1 - Slight and infrequent tremor

2 - Moderate tremor that is intermittent

3 - Moderate tremor that is present most of the time

4 - Severe tremor that is present most of the time

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23. LEFT LEG TREMOR

Which of the following best describes the amount of tremor in the left leg ?

0 - No tremor

1 - Slight and infrequent tremor

2 - Moderate tremor that is intermittent

3 - Moderate tremor that is present most of the time

4 - Severe tremor that is present most of the time

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24. BALANCE

On those days that you walk, which of the following best describes the frequency with which you fall due to walking difficulties ?

0 - None

1 - Rarely

2 - Occasionally (less than once per day)

3 - Falls an average of about once daily

4 - Falls more than once daily

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25. WALKING DIFFICULTIES

which of the following best describes the frequency with which you have to stop walking due to difficulties caused by Parkinson's disease?

0 - Normal

1 - Rarely

2 - Occasionally

3 - Frequently

4 - Unable to walk

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26. WALKING ABILITY

Which of the following best describes your general ability to walk ?

0 - Normal

1 - Mild difficulty. Walks slowly, and may shuffle with short steps

2 - Moderate difficulty, but requires no assistance. May shuffle or have short steps.

3 - Severe disturbance of walking, requiring assistance.

4 - Cannot walk at all, even with assistance.

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27. RIGHT FOOT RIGIDITY

Which of the following best describes your ability to tap your right heel on the ground in rapid succession ?

0 - Normal

1 - Mild slowing or reduction in amplitude

2 - Moderately impaired. Occasional hesitation or cessation of movement

3 - Severely impaired. Frequent hesitation or cessation of movement

4 - Can barely perform the task

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28. LEFT FOOT RIGIDITY

Which of the following best describes your ability to tap your left heel on the ground in rapid succession ?

0 - Normal

1 - Mild slowing or reduction in amplitude

2 - Moderately impaired. Occasional hesitation or cessation of movement

3 - Severely impaired. Frequent hesitation or cessation of movement

4 - Can barely perform the task

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29. POSTURE

Which of the following best describes your posture ?

0 - Normal

1 - Not quite erect, slightly stooped posture

2 - Moderately stooped posture, definitely abnormal

3 - Severely stooped posture

4 - Marked bending forward of the body with extreme abnormality of posture

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30. UPPER BODY MOVEMENT

Which of the following best describes your upper body movement ?

0 - Normal

1 - Minimal slowness, giving movement a deliberate character

2 - Mild degree of slowness and lack of movement, which is definitely abnormal

3 - Moderate slowness, and a moderate lack or small amplitude of movement

4 - Marked slowness, and a marked lack or small amplitude of movement

31. RESPIRATION

Which of the following best describes your breathing ?

0 - I can hold my breath for more than 20 seconds

1 - I can hold my breath for more than 10 seconds

2 - I can hold my breath for a few seconds

3 - I can not hold my breath but can breath normally

4 - Unable to breath normally

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32. URINARY FUNCTION

Which of the following best describes your urinary function ?

0 - Normal

1 - Greater urgency to urinate than is justified

2 - Occasionally urinate before going to the toilet

3 - Often urinate before going to the toilet

4 - No control over urination

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33. CONSTIPATION

Which of the following best describes your bowel function ?

0 - Daily

1 - At least three times a week

2 - Twice a week

3 - Once a week

4 - Bowels unable to function without assistance

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34. MUSCLE PAIN

Which of the following best describes the general feeling in your muscles ?

0 - Nothing unusual experienced

1 - Occasional numbness, tingling, or mild aching

2 - Frequent numbness, tingling, or mild aching

3 - Frequent painful sensations

4 - Excruciating pain

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35. MOOD

Which of the following best describes your general mood ?

0 - No sustained periods of depression

1 - Depressed for more than a day at a time but not for several days at a time

2 - Depressed for days or weeks at a time

3 - Continuous depression

4 -Continuous depression. Frequent suicidal thoughts or intent.

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36. MOTIVATION

Which of the following best describes your level of motivation ?

0 - Fairly normal level of motivation

1 - Distinctly less motivation and more passive than the average person

2 - Loss of initiative or disinterest in non-routine activities

3 - Loss of initiative or disinterest in day to day (routine) activities.

4 - Complete loss of motivation

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