Demographic Data |
Relation to Proband |
spouse |
Age at Sampling |
52 YR |
Gender |
Female |
Age of Onset(If not a control) |
No Data |
Age at Diagnosis(If not a control) |
No Data |
Hispanic or Latino/Not Hispanic or Latino |
Not Hispanic/Latino |
Racial Category |
White |
Country |
USA |
Diagnosed By |
No Data |
|
Data Elements |
Clinical Element Type: Control |
(Baseline) |
Data collected by |
This data was collected by |
Neurologist Other physician-non-Neurologist clinical research assistant/nurse |
Longitudinal Data |
Is this data Longitudinal (Follow-Up) Data? |
yes no |
Type of Control |
Type of Control |
Unaffected spouse |
Medical History |
Amyotrophic lateral sclerosis |
present absent |
Ataxia |
present absent |
Autism |
present absent |
Bipolar (manic-depressive) |
present absent |
Brain aneurysm |
present absent |
Cancer |
present absent |
Dementia |
Alzheimer's Dementia absent
|
Depression |
present absent |
Diabetes |
present absent |
Dystonia |
present absent |
Epilepsy |
present absent |
Heart disease |
present absent |
Hypertension |
present absent |
Memory loss |
present absent |
Migraine |
present absent |
Multiple sclerosis |
present absent |
Muscle disease |
present absent |
Obsessive Compulsive |
No Data |
Parkinson's |
present absent |
Schizophrenia |
present absent |
Stroke |
present absent |
Suicide/Attempt |
present absent |
Tourettes |
No Data |
Other |
present absent |
Family History |
Amyotrophic lateral sclerosis |
present absent |
Ataxia |
present absent |
Autism |
present absent |
Bipolar (manic-depressive) |
present absent |
Brain aneurysm |
present absent |
Cancer |
present absent Notes: FATHER |
Dementia |
Alzheimer's Dementia absent
Notes: M GRAND MOTHER |
Depression |
present absent |
Diabetes |
present absent |
Dystonia |
present absent |
Epilepsy |
present absent |
Heart disease |
present absent |
Hypertension |
present absent Notes: FATHER |
memory loss |
present absent |
Migraine |
present absent |
Multiple sclerosis |
present absent |
Muscle disease |
present absent |
Obsessive Compulsive |
No Data |
Parkinson's |
present absent |
Schizophrenia |
present absent |
Stroke |
present absent |
Suicide/Attempt |
present absent |
Tourettes |
No Data |
Other |
present absent |
Optional data |
smoking history |
never former smoker current smoker |
years smoking |
No Data |
Neurological examination |
yes no |
State Examination (MMSE) score |
No Data |
Handedness |
Right Left Ambidextrous |