Demographic Data |
Relation to Proband |
No Data |
Age at Sampling |
45 YR |
Gender |
Female |
Age of Onset(If not a control) |
39 YR |
Age at Diagnosis(If not a control) |
44 YR |
Hispanic or Latino/Not Hispanic or Latino |
Hispanic/Latino |
Racial Category |
More than one race |
Country |
USA |
Diagnosed By |
No Data |
|
Data Elements |
Clinical Element Type: Multiple System Atrophy |
(Baseline) |
Longitudinal Data |
Is this data Longitudinal (Follow-Up) Data? |
yes no |
Family History |
Family history of Multiple System Atrophy |
present absent |
Best Clinical Diagnosis |
Progressive supranuclear palsy |
present absent |
Diffuse Lewy Body disease |
present absent |
Multiple system atrophy |
present absent |
Gaze palsy |
present absent |
Alzheimer's disease |
present absent |
Corticobasal ganglionic degeneration |
present absent |
Dementia |
present absent |
Other (specify) |
present absent |
Signs suggestive of MSA diagnosis |
Orthostatic hypotension |
present absent |
Urinary incontinence |
present absent |
Incomplete bladder emptying |
present absent |
Bradykinesia |
present absent |
Rigidity |
present absent |
Postural Instability |
present absent |
Tremor |
present absent |
Gait ataxia |
present absent |
Ataxic dysarthria |
present absent |
Limb ataxia |
present absent |
Sustained gaze-evoked nystagmus |
present absent |
Extensor plantar responses with hyperreflexia |
present absent |
Features Suggestive of Another Diagnosis |
Responsive to Levodopa |
present absent |
Oculogyric crisis |
present absent |
Neuroleptic treatment onset |
present absent |
Hydrocephalus |
present absent |
Delusions |
present absent |
Early severe dementia |
present absent |
Whipple's disease |
present absent |
Focal sensory deficit |
present absent |
History of hypoxia/anoxia |
present absent |
History of alien limb syndrome |
present absent |
History of repeated strokes |
present absent |
History of encephalitis |
present absent |
Brain tumor |
present absent |
Prior history of repeated head injury |
present absent |
Optional data |
MSA Rating Scale Total Score |
No Data |
Clinical Element Type: Parkinsonism |
(Baseline) |
Longitudinal Data |
Is this data Longitudinal (Follow-Up) Data? |
yes no |
Family History |
Family history of parkinsonism |
present absent unknown (subject adopted) Notes: N/A-QUESTION NOT ASKED IN THIS STUDY |
Specific diagnosis |
Parkinsonism clinical diagnosis |
Parkinson's disease Progressive Supranuclear Palsy Diffuse Lewy Body Disease Multiple System Atrophy Others Unaffected primary blood relative of proband
|
Genetic Data of Subject |
Mutation/s in subject's DNA (if present, describe) |
present absent unknown |
Signs suggestive of PD diagnosis |
Asymmetric onset |
present absent |
Bradykinesis |
present absent |
Activation tremor |
present absent |
Resting Tremor |
present absent |
Postural Instability |
present absent |
Rigidity |
present absent |
Gait difficulties |
present absent |
Response to Anti-Parkinsonism Therapy |
tried and responsive inadequate dose not tried/not given tested and unresponsive |
Signs suggestive of another diagnosis |
history of strokes or stepwise deterioration |
present absent |
history of head injury with loss of consciousness |
present absent |
history of encephalitis |
present absent |
Oculogyric crisis |
present absent |
neuroleptic treatment at time of symptom onset |
present absent |
sustained remission |
present absent |
gaze palsy |
present absent |
Cerebellar signs (other than activation tremor) |
present absent |
Fluctuations |
present absent |
hallucinations |
present absent |
dysautonomia |
present absent |
Memory loss |
present absent |
axial rigidity |
present absent |
Other |
present absent |
Smoking History |
smoking history |
never former smoker current smoker |
years smoking |
No Data |
Optional data |
Mini-mental status score |
26 |
Hoehn and Yahr |
No Data |
UPDRS total motor score |
No Data |
Handedness |
Right Left Ambidextrous |