Brain Bank Form

Brain Bank Form and Dictionary

Brain Bank Form

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Brain Bank Form
Variable / Field Name Field Label Choices, Calculations, OR Slider Labels
udall_study_id Udall Study ID
date Date:
reviewer Reviewer:
does_the_subject_have_brad 1) Does the subject have bradykinesia? 1, Yes | 2, No | 3, Unknown
does_subject_have_muscular 2) Does subject have muscular rigidity? 1, Yes | 2, No | 3, Unknown
does_subject_have_4_6_hz_r Does subject have 4-6 Hz rest tremor? 1, Yes | 2, No | 3, Unknown
does_subject_have_postural Does subject have postural instability? 1, Yes | 2, No | 3, Unknown
i_postural_instability_mus Postural instability must not be caused by primary visual, vestibular, cerebellar, or proprioceptive dysfunction.
h5_step_2_exclusion_criter 3) Does the subject have any of the following:
exclusion 1, History of repeated strokes with stepwise progression of parkinsonian features | 2, History of repeated head injury | 3, History of definite encephalitis | 4, Oculogyric crises | 5, Neuroleptic treatment at onset of symptoms | 6, Sustained remission | 7, Strictly unilateral features after 3 years | 8, Supranuclear gaze palsy (other than restriction of upward gaze) | 9, Cerebellar signs | 10, Early severe autonomic involvement | 11, Early severe dementia with disturbances of memory, language, and praxis | 12, Babinski sign | 13, Presence of cerebral tumor or communicating hydrocephalus on CT scan | 14, Negative response to large doses of levodopa (if malabsorption excluded) | 15, MPTP exposure
unilateral_onset 4) Unilateral Onset 1, Yes | 2, No | 3, Unknown
rest_tremor_present 5) Rest tremor present 1, Yes | 2, No | 3, Unknown
progressive_disorder 6) Progressive disorder 1, Yes | 2, No | 3, Unknown
persistent_asymmetry_affec 7) Persistent asymmetry affecting side of onset most 1, Yes | 2, No | 3, Unknown
severe_levodopa_induced_ch 9) Severe levodopa-induced chorea 1, Yes | 2, No | 3, Unknown
levodopa_response_for_5_ye 10) Levodopa response for 5 years or more 1, Yes | 2, No | 3, Unknown
clinical_course_of_10_year 11) clinical course of 10 years or more 1, Yes | 2, No | 3, Unknown
font_color_red_subject_mee
Subject meets UKPDSBB Clinical Diagnostic Criteria
 1, Yes | 2, No | 3, Unknown
other_description
other
hoehn_yahr_stage 12) Hoehn & Yahr Stage: 1, 1 | 1.5, 1.5 | 2, 2 | 2.5, 2.5 | 3, 3 | 4, 4 | 5, 5
documented_orthostatic_hyp 13) documented orthostatic hypotension 1, Yes | 2, No | 3, Unknown
peripheral_neuropathy 14) Peripheral neuropathy 1, Yes | 2, No | 3, Unknown
history_of_hyperkinesia 15) History of hyperkinesia 1, Yes | 2, No | 3, Unknown
history_of_dystonia 16) History of dystonia 1, Yes | 2, No | 3, Unknown
dementia 17) Dementia 1, Yes | 2, No | 3, Unknown
neurologist 18) Neurologist: 1, Agarwal | 2, Gerton | 3, Griffith | 4, Hu | 5, Kim | 6, Ro | 7, Roberts | 8, Samii | 9, Other
otherneurologist other:
descriptive2 ____________________________________________________________________________________________________________________________________________
are_there_any_medical_neur Are there any medical, neurological, or psychiatric conditions, other than PD, that you are aware of that could compromise this subject's cognition.