ADRC B2 Evaluation Form and Dictionary
| B2 Evaluation Form | ||
|
Download Dictionary: |
||
| Variable / Field Name | Field Label | Choices, Calculations, OR Slider Labels |
|---|---|---|
| b2_adcid | Site: 39 ADCID | b2_ptid | Subject ID: PTID | b2_visitdate | Form Date: (Y-M-D) | b2_visitnum | Visit number: 1 (Initial visit), 2 and up (Follow up visit) VISITNUM | b2_initials | Examiner's initials: INITIALS | b2_ent_date | Data Entry Date: (Y-M-D) | b2_ent_by | Data Entry By | b2_admin_st | Administered Status | 1, 1 Yes | 95, 95 - No, Physical problem | 96, 96 - No, Cognitive/behavior problem | 97, 97 - No, Other problem | 98, 98 - No, Verbal refusal | 99, 99 - Not Administered | b2_height_00 | HACHINSKI ISCHEMIC SCORE Please complete the following scale using information obtained from history/physical/neurological exam and/or medical records. Circle the appropriate value to indicate if a specific item is present (characteristic of the patient) or absent. | b2_abr_onset | 1. Abrupt onset (re: cognitive status) | 2, 2 Present | 0, 0 Absent | b2_step_det_00 | b2_step_det | 2. Stepwise deterioration (re: cognitive status) | 1, 1 Present | 0, 0 Absent | b2_somatic_compl_00 | b2_somatic_compl | 3. Somatic complaints | 1, 1 Present | 0, 0 Absent | b2_emot_incon_00 | b2_emot_incon | 4. Emotional incontinence | 1, 1 Present | 0, 0 Absent | b2_hyper_00 | b2_hyper | 5. History or presence of hypertension | 1, 1 Present | 0, 0 Absent | b2_stroke_00 | b2_stroke | 6. History of stroke | 2, 2 Present | 0, 0 Absent | b2_neu_symp_00 | b2_neu_symp | 7. Focal neurological symptoms | 2, 2 Present | 0, 0 Absent | b2_neu_sign_00 | b2_neu_sign | 8. Focal neurological signs | 2, 2 Present | 0, 0 Absent | b2_tot_00 | b2_tot | 9. Sum all circled answers for a Total Score | [b2_abr_onset]+[b2_step_det]+[b2_somatic_compl]+[b2_emot_incon]+[b2_hyper]+[b2_stroke]+[b2_neu_symp]+[b2_neu_sign] | note | NOTE: this form is to be completed by the clinician or other trained health professional. For additional clarification and examples, see UDS Coding Guidebook for Initial Visit Packet, Form B2. | using_your_best_judgement | 10. Using your best judgement, do you believe that cerebrovascular disease (CVD) is contributing to the cognitive impairment? | 1, Yes | 2, No | 3, N/A | if_there_is_a_stroke_is_th | 11. If there is a stroke, is there a temporal relationship between stroke and onset of cognitive impairment? | 1, Yes | 2, No | 3, N/A | is_there_imaging_evidence | 12. Is there imaging evidence which support that CVD is contributing to the cognitive impariment? | 1, Yes | 2, No | 3, N/A | a_if_yes_indicate_which_im | 1) Single strategic infarct | 1, Yes | 2, No | multiple_infarcts | 2) Multiple infarcts | 1, Yes | 2, No | extensive_white_matter_hyp | 3) Extensive white matter hyperintensity | 1, Yes | 2, No | other | 4) Other | 1, Yes | 2, No | b2_12a_specify | If other, specify: | can_the_patient_live_on_th | Can the patient live on their own for 1 week? | updrs_part_iii_postural_st | UPDRS Part III Postural Stability | 5, 0 = 2 or less | 1, 1 = 2.5 | 2, 2 = 2.5 | 3, 3 = 3 or more | 4, 4 = 4 or 5 |