| Demographic Data |
| Relation to Proband |
parent |
| Age at Sampling |
52 YR |
| Sex |
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 |
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 |
Related to an affected individual (REQUIRES SPECIAL APPROVAL) |
| 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 |
present absent |
| Parkinson's |
present absent |
| Schizophrenia |
present absent |
| Stroke |
present absent |
| Suicide/Attempt |
present absent |
| Tourettes |
present absent |
| Other |
present absent
Notes: |
| Family History |
| Amyotrophic lateral sclerosis |
present absent
Notes: |
| Ataxia |
present absent
Notes: |
| Autism |
present absent
Notes: |
| Bipolar (manic-depressive) |
present absent
Notes: brother & sister, several paternal cousins |
| Brain aneurysm |
present absent
Notes: |
| Cancer |
present absent
Notes: brother (colon), brother (squamous cells), niece (thyroid) & nephew (testicular), maternal uncle (lung) |
| Dementia |
Alzheimer's
Dementia
absent
Notes: ALZ: paternal aunt|DEM: paternal aunt |
| Depression |
present absent
Notes: two paternal aunts, maternal cousin |
| Diabetes |
present absent
Notes: brother |
| Dystonia |
present absent
Notes: |
| Epilepsy |
present absent
Notes: ND35230(Child) |
| Heart disease |
present absent
Notes: maternal grandparents |
| Hypertension |
present absent
Notes: maternal aunt |
| memory loss |
present absent
Notes: |
| Migraine |
present absent
Notes: |
| Multiple sclerosis |
present absent
Notes: |
| Muscle disease |
present absent
Notes: |
| Obsessive Compulsive |
present absent
Notes: |
| Parkinson's |
present absent
Notes: |
| Schizophrenia |
present absent
Notes: brother, paternal cousin |
| Stroke |
present absent
Notes: |
| Suicide/Attempt |
present absent
Notes: |
| Tourettes |
present absent
Notes: |
| Other |
present absent
Notes: |
| Optional data |
| smoking history |
never former smoker current smoker |
| years smoking |
0 |
| Neurological examination |
yes no |
| State Examination (MMSE) score |
No Data |
| Handedness |
Right Left Ambidextrous |