Health-IQ Form

Health-IQ Form and Dictionary

Health-IQ Form

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Health-IQ Form

Variable / Field Name Field Label Choices, Calculations, OR Slider Labels
healthiq_adcid Site: 39 ADCID
healthiq_ptid Subject ID: PTID
healthiq_id Health IQ ID:
healthiq_id_2 Health IQ ID 2:
healthiq_ent_date Data Entry Date: (Y-M-D)
healthiq_ent_by Data Entry By:
healthiq_visitdate Eval Date: (Y-M-D)
healthiq_score_date Score Date: (Y-M-D)
healthiq_text_00 =======================================================================================================
healthiq_pt_name Full Name
healthiq_ethnicity Ethnicity 1, 1 Caucasian | 2, 2 Hispanic | 3, 3 Asian | 4, 4 African American | 5, 5 Other
healthiq_ethnicity_other If Other
healthiq_age Age
healthiq_educ Education
healthiq_device What device are you using to complete testing today?
healthiq_mouse_touch Are you using a mouse or touchscreen? 1, 1 Mouse | 2, 2 Touchscreen | 3, 3 Trackpad
healthiq_pt_dx Patient Dx Group 1, 1 HC - Healthy Control | 2, 2 AD - Alzheimer's Disease | 3, 3 MCI - Mild Cognitive Impairment | 4, 4 PD - Parkinson's Disease | 5, 5 PDMCI - Parkinson's Disease and Mild Cognitive Impairment | 6, 6 HC changed to MCI | 7, 7 LBD - Lewy Body Disease
healthiq_text_01 =======================================================================================================
healthiq_1a 1a. First Name
healthiq_1b 1b. Last Name
healthiq_1_score 1. Total Score Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_2 2. Birth Place
healthiq_2_score 2. Total Score Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_3 3. Age
healthiq_3_score 3. Total Score Max Score = 1 1, 1 | 0, 0
healthiq_4a 4a. Birthdate: Day
healthiq_4b 4b. Birthdate: Month
healthiq_4c 4c. Birthdate: Year
healthiq_4_score 4. Total Score Max Score = 3 1, 3 | 2, 2 | 3, 1 | 0, 0
healthiq_text_02 =======================================================================================================
health_iq_immed_recall Please repeat this name and address after me. 1, John | 2, Brown | 3, 42 | 4, Market Street | 5, Chicago
health_iq_immed_recall_2 Please repeat this name and address after me. 1, John | 2, Brown | 3, 42 | 4, Market Street | 5, Chicago
health_iq_immed_recall_3 Please repeat this name and address after me. 1, John | 2, Brown | 3, 42 | 4, Market Street | 5, Chicago
healthiq_text_03 =======================================================================================================
healthiq_5 5. What time is it?
healthiq_5_score 5. Total Score Max Score = 1 1, 1 | 0, 0
healthiq_text_04 =======================================================================================================
healthiq_6 6. Please count backwards from 20 to 1. 1, 20 | 2, 19 | 3, 18 | 4, 17 | 5, 16 | 6, 15 | 7, 14 | 8, 13 | 9, 12 | 10, 11 | 11, 10 | 12, 9 | 13, 8 | 14, 7 | 15, 6 | 16, 5 | 17, 4 | 18, 3 | 19, 2 | 20, 1
healthiq_6_score 6. Total Score (T, Tm) Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_7 7. Please count backwards from 20 to 1. 1, 20 | 2, 19 | 3, 18 | 4, 17 | 5, 16 | 6, 15 | 7, 14 | 8, 13 | 9, 12 | 10, 11 | 11, 10 | 12, 9 | 13, 8 | 14, 7 | 15, 6 | 16, 5 | 17, 4 | 18, 3 | 19, 2 | 20, 1
healthiq_7_score 7. Total Score (0) Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_text_05 =======================================================================================================
healthiq_8a 8a. Please list all 12 months of the year in backwards order. 1, Dec | 2, Nov | 3, Oct | 4, Sep | 5, Aug | 6, Jul | 7, Jun | 8, May | 9, Apr | 10, Mar | 12, Feb | 13, Jan
healthiq_8b 8b. Time (seconds)
healthiq_8_score 8. Total Score (0) Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_text_06 =======================================================================================================
health_iq_10 10. Can you please repeat the name and address I asked you to remember? 1, John | 2, Brown | 3, 42 | 4, Market Street | 5, Chicago
healthiq_10_score 10. Total Score Max Score = 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_text_07 =======================================================================================================
healthiq_11 11. Please repeat the following words after me. 1, Shirt | 2, Black | 3, Honesty
healthiq_11_1 11. Please repeat the following words after me. 1, Shirt | 2, Black | 3, Honesty
healthiq_11_2 11. Please repeat the following words after me. 1, Shirt | 2, Black | 3, Honesty
healthiq_11_score 11. Total Score Max Score = 1
healthiq_text_08 =======================================================================================================
healthiq_12 12. Please count backwards from 5 to 1.
healthiq_12_score 12. Total Score Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_text_09 =======================================================================================================
healthiq_13 13. Please spell the word "WORLD" backwards.
healthiq_13_score 13. Total Score Max Total = 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_text_10 =======================================================================================================
healthiq_14a 14a. Recall with no cue 1, Shirt | 2, Black | 3, Honesty
healthiq_14b 14b. Recall with category cue 1, Shirt | 2, Black | 3, Honesty
healthiq_14c 14c. Recall with multiple choice cue 1, Shirt | 2, Black | 3, Honesty
healthiq_14_score 14. Total Score Max Score = 9 1, 9 | 2, 8 | 3, 7 | 4, 6 | 5, 5 | 6, 4 | 7, 3 | 8, 2 | 9, 1 | 0, 0
healthiq_15_score 15. Total Score Max Score = 3 1, 3 | 2, 2 | 3, 1 | 0, 0
healthiq_text_11 =======================================================================================================
healthiq_16a 16a. Year
healthiq_16b 16b. Month
healthiq_16c 16c. Date
healthiq_16d 16d. Day of the Week
healthiq_16e 16e. Season
healthiq_16_score 16. Total Score: Date (3M) Max Score = 15 1, 15 | 2, 14 | 3, 13 | 4, 12 | 5, 11 | 6, 10 | 7, 9 | 8, 8 | 9, 7 | 10, 6 | 11, 5 | 12, 4 | 13, 3 | 14, 2 | 15, 1 | 0, 0
healthiq_17_score 17. Total Score: Date (M) Max Score = 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_18_score 18. Total Score: Year Max Score = 1 1, 1 | 0, 0
healthiq_19_score 19. Total Score: Month Max Score = 1 1, 1 | 0, 0
healthiq_20_score 20. Total Score: Date (Mo) Max Score = 4 1, 4 | 2, 3 | 3, 2 | 4, 1 | 0, 0
healthiq_21_score 21. Total Score: Date (T, Tm) Max Score = 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_text_12 =======================================================================================================
healthiq_22a 22a. Place
healthiq_22b 22b. House Number
healthiq_22c 22c. Street
healthiq_22d 22d. City
healthiq_22d_m 22d. City (M)
healthiq_22e 22e. County
healthiq_22f 22f. State
healthiq_22g 22g. Zip Code
healthiq_22h 22h. Location Query
healthiq_22i 22i. Floor
healthiq_22_score 22. Total Score (3M) Max Score = 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_23_score 23. Total Score (M) Max Score = 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_24_score 24. Total Score (Mo) Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_25_score 25. Total Score (T) Max Score = 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_text_13 =======================================================================================================
healthiq_26 26. Naming 1, Pencil | 2, Watch | 3, Forehead | 4, Chin | 5, Shoulder | 6, Elbow | 7, Knuckle
health_iq_26_incorrect Incorrect Responses:
healthiq_26_score 26. Total Score: Naming (3M) Max Score: 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_27_score 27. Total Score: Naming (M) Max Score: 2 1, 2 | 2, 1 | 0, 0
healthiq_text_14 =======================================================================================================
healthiq_28_score 28. Total Score: Animals Max Score = 10
healthiq_29_score 29. Total Score: Animals 1-30 Max Score = 50
healthiq_30_score 30. Total Score: Animals 31-60 Max Score = 50
health_iq_animal_rep Animals: Repetitions
health_iq_animal_intrusion Animals: Intrusions
health_iq_animal_rv Animals: Rule Violations
healthiq_text_15 =======================================================================================================
healthiq_31a 31a. Arm/Leg
healthiq_31a_score 31a. Total Score Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_31b 31b. Laughing/Crying
healthiq_31b_score 31b. Total Score Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_31c 31c. Eating/Sleeping
healthiq_31c_score 31c. Total Score Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_31d 31d. Train/Bicycle
healthiq_31d_score 31d. Total Score Max Score = 1 1, 1 | 0, 0
healthiq_31e 31e. Watch/Ruler
healthiq_31e_score 31e. Total Score Max Score = 1 1, 1 | 0, 0
healthiq_31_score 31. Total Score (3M) Max Score = 6 1, 6 | 2, 5 | 3, 4 | 4, 3 | 5, 2 | 6, 1 | 0, 0
healthiq_32_score 32. Total Score (Mo) Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_text_16 =======================================================================================================
healthiq_33a 33a. Please repeat this after me. 1, He | 2, would | 3, like | 4, to | 5, go | 6, home
healthiq_33a_score 33a. Score Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_33b 33b. Please repeat this after me. 1, No | 2, ifs, | 3, ands, | 4, or | 5, buts
healthiq_33b_score_1 33b. Score Max Score = 3 1, 3 | 2, 2 | 3, 1 | 0, 0
healthiq_33b_score_2 33b. Score Max Score = 1 1, 1 | 0, 0
healthiq_33b_score_3 33b. Score Max Score = 1 1, 1 | 0, 0
healthiq_33c 33c. Please repeat this after me. 1, Methodist | 2, Episcopal
healthiq_33c_score 33c. Score Max Score = 1 1, 1 | 0, 0
healthiq_33_score 33. Total Score (3M) Max Score = 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_34_score 34. Total Score (M) Max Score = 1 1, 1 | 0, 0
healthiq_35_score 35. Total Score (T, Tm) Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_text_17 =======================================================================================================
healthiq_36 36. Close Your Eyes
healthiq_36_score 36. Total Score (3M) Max Score = 3 1, 3 | 2, 2 | 3, 1 | 0, 0
healthiq_37_score 37. Total Score (M) Max Score = 1 1, 1 | 0, 0
healthiq_text_18 =======================================================================================================
healthiq_38 38. I Would Like To Go Out
healthiq_38_score 38. Total Score (3M) Max Score = 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_39_score 39. Total Score (M) Max Score = 1 1, 1 | 0, 0
healthiq_40a 40a. Pentagon-1 1, 4 | 2, 3 | 3, 2 | 4, 1 | 0, 0
healthiq_40b 40b. Pentagon-2 1, 4 | 2, 3 | 3, 2 | 4, 1 | 0, 0
healthiq_40c 40c. Intersection 1, 2 | 2, 1 | 0, 0
healthiq_40_score 40. Total Score (3M) Max Score = 10 1, 10 | 2, 9 | 3, 8 | 4, 7 | 5, 6 | 6, 5 | 7, 4 | 8, 3 | 9, 2 | 10, 1 | 0, 0
healthiq_41_score 41. Total Score (M) Max Score = 1 1, 1 | 0, 0
healthiq_text_19 =======================================================================================================
healthiq_42a 42a. Takes paper with left hand 1, 1 | 0, 0
healthiq_42b 42b. Folds paper in half 1, 1 | 0, 0
healthiq_42c 42c. Sets the paper on the floor 1, 1 | 0, 0
healthiq_42_score 42. Total Score Max Score = 3 1, 3 | 2, 2 | 3, 1 | 0, 0
healthiq_text_20 =======================================================================================================
healthiq_43a 43a. With no cue 1, Shirt | 2, Black | 3, Honesty
healthiq_43b 43b. Category cue 1, Shirt | 2, Black | 3, Honesty
healthiq_43c 43c. Multiple Choice Cue 1, Shirt | 2, Black | 3, Honesty
healthiq_43_score 43. Total Score Max Score = 9 1, 9 | 2, 8 | 3, 7 | 4, 6 | 5, 5 | 6, 4 | 7, 3 | 8, 2 | 9, 1 | 0, 0
healthiq_text_21 =======================================================================================================
healthiq_44 44. Trails MoCA
healthiq_44_score 44. Total Score Max Score = 1 1, 1 | 0, 0
healthiq_text_22 =======================================================================================================
healthiq_45 45. Necker Cube 1, 1 | 0, 0
healthiq_text_23 =======================================================================================================
healthiq_46a 46a. Contour 1, 1 | 0, 0
healthiq_46b 46b. Numbers 1, 1 | 0, 0
healthiq_46c 46c. Hands 1, 1 | 0, 0
healthiq_46_score 46. Total Score Max Score = 3 1, 3 | 2, 2 | 3, 1 | 0, 0
healthiq_text_24 =======================================================================================================
healthiq_47a 47. Naming 1, Lion | 2, Rhinoceros/Rhino | 3, Camel/Dromedary
healthiq_47_incorrect Incorrect Responses:
healthiq_47_score 47. Total Score Max Score = 3 1, 3 | 2, 2 | 3, 1 | 0, 0
healthiq_text_25 =======================================================================================================
healthiq_word_list_1 Please tell me all the words that you remember. 1, Face | 2, Velvet | 3, Church | 4, Daisy | 5, Red
healthiq_word_list_2 Please tell me all the words that you remember. 1, Face | 2, Velvet | 3, Church | 4, Daisy | 5, Red
healthiq_text_26 =======================================================================================================
healthiq_48 48. Digits Forward
healthiq_48_score 48. Total Score Max Score = 1 1, 1 | 0, 0
healthiq_49 49. Digits Backwards
healthiq_49_score 49. Total Score Max Score = 1 1, 1 | 0, 0
healthiq_text_27 =======================================================================================================
healthiq_50_score 50. Letter Tapping Total Score Max Score = 1 1, 1 | 0, 0
healthiq_text_28 =======================================================================================================
healthiq_51 51. Serial Sevens
healthiq_51_score 51. Total Score (Mo) Max Score = 3 1, 3 | 2, 2 | 3, 1 | 0, 0
healthiq_52 52. Total Score (T, Tm) Max Score = 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_text_29 =======================================================================================================
healthiq_53a 53a. Please repeat this after me. 1, I | 2, only | 3, know | 4, that | 5, John | 6, is | 7, the | 8, one | 9, to | 10, help | 11, today.
healthiq_53b 53b. Please repeat this after me. 1, The | 2, cat | 3, always | 4, hid | 5, under | 6, the | 7, couch | 8, when | 9, dogs | 10, were | 11, in | 12, the | 13, room.
healthiq_53_score 53. Total Score Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_text_30 =======================================================================================================
healthiq_54 54. F Words Max Score = 1 1, 1 | 0, 0
healthiq_55 55. F Words 1-30 Max Score = 50
healthiq_56 56. F Words 30-60 Max Score = 50
healthiq_f_repetitions F Word Repetitions:
healthiq_f_intrusions F Word Intrusions:
healthiq_f_rv F Word Rule Violations:
healthiq_text_31 =======================================================================================================
healthiq_57a 57a. No Cue 1, Face | 2, Velvet | 3, Church | 4, Daisy | 5, Red
healthiq_57b 57b. Category Cue 1, Face | 2, Velvet | 3, Church | 4, Daisy | 5, Red
healthiq_57c 57c. Multiple Choice Cue 1, Face | 2, Velvet | 3, Church | 4, Daisy | 5, Red
healthiq_57_score 57. Total Score Max Score = 5 1, 5 | 2, 4 | 3, 3 | 4, 2 | 5, 1 | 0, 0
healthiq_text_32 =======================================================================================================
healthiq_58 58. Immediate Recall 1, Cabin | 2, Pipe | 3, Elephant | 4, Chest | 5, Silk | 6, Theater | 7, Watch | 8, Whip | 9, Pillow | 10, Giant
healthiq_58_score 58. Total Score Max Score = 10 1, 10 | 2, 9 | 3, 8 | 4, 7 | 5, 6 | 6, 5 | 7, 4 | 8, 3 | 9, 2 | 10, 1 | 0, 0
healthiq_text_33 =======================================================================================================
healthiq_59 59. Telephone
healthiq59_score 59. Total Score Max Score = 1 1, 1 | 0, 0
healthiq_text_34 =======================================================================================================
healthiq_60a 60a. Scissors/Shears 1, 1 Scissors/Shears | 0, 0 Other
healthiq_60b 60b. 12 1, 1 12 | 0, Other
healthiq_60c 60c. Cactus 1, 1 Cactus | 0, 0 Other
healthiq_60d 60d. Sheep/Lamb 1, 1 Sheep/Lamb | 0, 0 Other
healthiq_60 60. Total Score Max Score = 4 1, 4 | 2, 3 | 3, 2 | 4, 1 | 0, 0
healthiq_text_35 =======================================================================================================
healthiq_61a 61a. President
healthiq_61b 61b. Vice-President
healthiq_60_score 61. Total Score (T) Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_62 62. Total Score (Tm) Max Score = 4 1, 4 | 2, 3 | 3, 2 | 4, 1 | 0, 0
healthiq_text_36 =======================================================================================================
healthiq_63 63. Finger Tapping 1, 2 | 2, 1 | 0, 0
healthiq_text_37 =======================================================================================================
healthiq_64a 64a. West 1, 1 East | 0, 0 Other
healthiq_64b 64b. Generous 1, 1 Cheap, Stingy, Tight, Selfish, Greedy, Mean, Meager, or other correct antonym | 0, 0 Other
healthiq_64_score 64. Antonyms Total Score Max Score = 2 1, 2 | 2, 1 | 0, 0
healthiq_text_38 =======================================================================================================
healthiq_65 65. Delayed Recall 1, Cabin | 2, Pipe | 3, Elephant | 4, Chest | 5, Silk | 6, Theater | 7, Watch | 8, Whip | 9, Pillow | 10, Giant
healthiq_65_score 65. Total Score Max Score = 10 1, 10 | 2, 9 | 3, 8 | 4, 7 | 5, 6 | 6, 5 | 7, 4 | 8, 3 | 9, 2 | 10, 1 | 0, 0