Table | Survey Name |
---|---|
Demographics | Demographics |
CurrentMedications | Current Medications |
QualityofLife | Quality of Life |
EverydayCognition | Everyday Cognition |
MedicalHistory | Medical History |
Sleep | Sleep |
Mood | Mood |
FamilyTree | Family Tree |
Monthly Questionnaire | Monthly Questionnaire (Baseline) |
Column Name | Question Text | Codes |
---|---|---|
QID177 | What is your weight (lbs)? |
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QID178 | What is your height (ft'in")? |
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QID180 | What is your current marital status? |
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QID189 | Please indicate your primary residence type |
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QID182 | What is/was the field of your primary occupation during most of adult life |
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QID183 | Please indicate *Other occupation |
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QID185 | Are you retired? |
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QID186 | Year of retirement |
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QID192 | Are you a veteran of the Armed Forces? |
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QID193 | Please indicate which branch of the Armed Forces |
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Column Name | Question Text | Codes |
---|---|---|
QID9_1 | Are you currently taking any of the following medications? Anti-psychotic medication (for example: risperidone - Risperdal; olanzapine - Zyprexa; quetiapine = Seroquel; aripiprazole = Abilify | |
QID9_2 | Are you currently taking any of the following medications? (Donepezil = Aricept; rivastigmine = Exelon; galantamine = Razadyne; memantine = Namenda) | |
QID9_3 | Are you currently taking any vitamins or supplements? |
Column Name | Question Text | Codes |
---|---|---|
QID80 | In general, would you say your health is: |
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QID81 | Compared to one year ago, how would you rate your health in general now? |
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QID82_1 | The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports |
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QID82_2 | The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf |
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QID82_3 | The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Lifting or carrying groceries |
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QID82_4 | The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Climbing several flights of stairs |
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QID82_5 | The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Climbing one flight of stairs |
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QID82_6 | The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Bending, kneeling, or stooping |
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QID82_7 | The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Walking more than a mile |
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QID82_8 | The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Walking several blocks |
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QID82_9 | The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Walking one block |
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QID82_10 | The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Bathing or dressing yourself |
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QID83_1 | During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Cut down the amount of time you spent on work or other activities |
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QID83_2 | During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Accomplished less than you would like |
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QID83_3 | During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Were limited in the kind of work or other activities |
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QID83_4 | During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Had difficulty performing the work or other activities (for example, it took extra effort) |
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QID84_1 | During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? Cut down the amount of time you spent on work or other activities |
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QID84_2 | During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? Accomplished less than you would like |
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QID84_3 | During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? Didn't do work or other activities as carefully as usual |
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QID85 | During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups? |
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QID86 | How much bodily pain have you had during the past 4 weeks? |
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QID87 | During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? |
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QID140_1 | These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... Did you feel full of pep? |
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QID140_2 | These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... Have you been a very nervous person? |
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QID140_3 | These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... Have you felt so down in the dumps that nothing could cheer you up? |
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QID140_4 | These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... Have you felt calm and peaceful? |
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QID140_5 | These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... Did you have a lot of energy? |
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QID140_6 | These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... Have you felt downhearted and blue? |
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QID140_7 | These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... Did you feel worn out? |
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QID140_8 | These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... Have you been a happy person? |
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QID140_9 | These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... Did you feel tired? |
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QID88 | During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)? |
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QID89_1 | How TRUE or FALSE is each of the following statements for you? I seem to get sick a little easier than other people |
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QID89_2 | How TRUE or FALSE is each of the following statements for you? I am as healthy as anybody I know |
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QID89_3 | How TRUE or FALSE is each of the following statements for you? I expect my health to get worse |
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QID89_4 | How TRUE or FALSE is each of the following statements for you? My health is excellent |
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Column Name | Question Text | Codes |
---|---|---|
QID49_1 | Compared to 10 years ago, has there been any change in... MEMORY Remembering a few shopping items without a list. |
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QID49_2 | Compared to 10 years ago, has there been any change in... MEMORY Remembering things that happened recently (such as recent outings, events in the news). |
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QID49_3 | Compared to 10 years ago, has there been any change in... MEMORY Recalling conversations a few days later. |
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QID49_4 | Compared to 10 years ago, has there been any change in... MEMORY Remembering where I have placed objects. |
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QID49_5 | Compared to 10 years ago, has there been any change in... MEMORY Repeating stories and/or questions. |
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QID49_6 | Compared to 10 years ago, has there been any change in... MEMORY Remembering the current date or day of the week. |
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QID49_7 | Compared to 10 years ago, has there been any change in... MEMORY Remembering I have already told someone something. |
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QID49_8 | Compared to 10 years ago, has there been any change in... MEMORY Remembering appointments, meetings, or engagements. |
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QID50_1 | Compared to 10 years ago, has there been any change in... LANGUAGE Forgetting the names of objects. |
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QID50_2 | Compared to 10 years ago, has there been any change in... LANGUAGE Verbally giving instructions to others. |
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QID50_3 | Compared to 10 years ago, has there been any change in... LANGUAGE Finding the right words to use in a conversation. |
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QID50_4 | Compared to 10 years ago, has there been any change in... LANGUAGE Communicating thoughts in a conversation. |
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QID50_5 | Compared to 10 years ago, has there been any change in... LANGUAGE Following a story in a book or on TV. |
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QID50_6 | Compared to 10 years ago, has there been any change in... LANGUAGE Understanding the point of what other people are trying to say. |
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QID50_7 | Compared to 10 years ago, has there been any change in... LANGUAGE Remembering the meaning of common words. |
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QID50_8 | Compared to 10 years ago, has there been any change in... LANGUAGE Describing a program I have watched on TV. |
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QID50_9 | Compared to 10 years ago, has there been any change in... LANGUAGE Understanding spoken directions or instructions. |
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QID51_1 | Compared to 10 years ago, has there been any change in... VISUAL-SPATIAL AND PERCEPTUAL ABILITIES Following a map to find a new location. |
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QID51_2 | Compared to 10 years ago, has there been any change in... VISUAL-SPATIAL AND PERCEPTUAL ABILITIES Reading a map and helping with directions when someone else is driving. |
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QID51_3 | Compared to 10 years ago, has there been any change in... VISUAL-SPATIAL AND PERCEPTUAL ABILITIES Finding my car in a parking lot. |
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QID51_4 | Compared to 10 years ago, has there been any change in... VISUAL-SPATIAL AND PERCEPTUAL ABILITIES Finding my way back to a meeting spot in the mall or other location. |
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QID51_5 | Compared to 10 years ago, has there been any change in... VISUAL-SPATIAL AND PERCEPTUAL ABILITIES Finding my way around a familiar neighborhood. |
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QID51_6 | Compared to 10 years ago, has there been any change in... VISUAL-SPATIAL AND PERCEPTUAL ABILITIES Finding my way around a familiar store. |
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QID51_7 | Compared to 10 years ago, has there been any change in... VISUAL-SPATIAL AND PERCEPTUAL ABILITIES Finding my way around a house visited many times. |
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QID52_1 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: PLANNING Planning a sequence of stops on a shopping trip. |
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QID52_2 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: PLANNING The ability to anticipate weather changes and plan accordingly (i.e., bring a coat or umbrella). |
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QID52_3 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: PLANNING Developing a schedule in advance of anticipated events. |
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QID52_4 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: PLANNING Thinking things through before acting. |
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QID52_5 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: PLANNING Thinking ahead. |
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QID53_1 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: ORGANIZATION Keeping living and work space organized. |
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QID53_2 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: ORGANIZATION Balancing the checkbook without error. |
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QID53_3 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: ORGANIZATION Keeping financial records organized. |
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QID53_4 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: ORGANIZATION Prioritizing tasks by importance. |
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QID53_5 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: ORGANIZATION Keeping mail and papers organized. |
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QID53_6 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: ORGANIZATION Using an organized strategy to manage a medication schedule involving multiple medications. |
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QID54_1 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: DIVIDED ATTENTION The ability to do two things at once. |
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QID54_2 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: DIVIDED ATTENTION Returning to a task after being interrupted. |
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QID54_3 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: DIVIDED ATTENTION The ability to concentrate on a task without being distracted by external things in the environment. |
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QID54_4 | Compared to 10 years ago, has there been any change in... EXECUTIVE FUNCTIONING: DIVIDED ATTENTION Cooking or working and talking at the same time. |
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Column Name | Question Text | Codes |
---|---|---|
QID1_1 | Please indicate whether you currently have or have had any of the following conditions in the past. Parkinson's disease |
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QID1_2 | Please indicate whether you currently have or have had any of the following conditions in the past. Movement disorder |
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QID1_3 | Please indicate whether you currently have or have had any of the following conditions in the past. Stroke |
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QID1_4 | Please indicate whether you currently have or have had any of the following conditions in the past. Motor neuron disease |
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QID1_5 | Please indicate whether you currently have or have had any of the following conditions in the past. Dementia |
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QID1_6 | Please indicate whether you currently have or have had any of the following conditions in the past. Heart disease |
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QID1_7 | Please indicate whether you currently have or have had any of the following conditions in the past. High blood pressure |
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QID1_8 | Please indicate whether you currently have or have had any of the following conditions in the past. High cholesterol |
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QID1_9 | Please indicate whether you currently have or have had any of the following conditions in the past. Diabetes |
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QID1_10 | Please indicate whether you currently have or have had any of the following conditions in the past. Cancer |
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QID1_12 | Please indicate whether you currently have or have had any of the following conditions in the past. Alzheimer's Disease |
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QID1_13 | Please indicate whether you currently have or have had any of the following conditions in the past. Mild Cognitive Impairment |
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QID1_14 | Please indicate whether you currently have or have had any of the following conditions in the past. Traumatic Brain Injury |
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QID1_15 | Please indicate whether you currently have or have had any of the following conditions in the past. Lung Disease |
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QID1_16 | Please indicate whether you currently have or have had any of the following conditions in the past. Asthma |
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QID1_17 | Please indicate whether you currently have or have had any of the following conditions in the past. Arthritis |
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QID1_18 | Please indicate whether you currently have or have had any of the following conditions in the past. Concussion |
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QID1_19 | Please indicate whether you currently have or have had any of the following conditions in the past. Epilepsy or Seizures |
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QID1_20 | Please indicate whether you currently have or have had any of the following conditions in the past. Hearing Loss |
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QID1_21 | Please indicate whether you currently have or have had any of the following conditions in the past. Multiple Sclerosis (MS) |
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QID1_22 | Please indicate whether you currently have or have had any of the following conditions in the past. Frontotemporal Dementia (FTD) |
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QID1_23 | Please indicate whether you currently have or have had any of the following conditions in the past. Lewy Body Disease (LBD) |
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QID1_24 | Please indicate whether you currently have or have had any of the following conditions in the past. Essential Tremor |
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QID1_25 | Please indicate whether you currently have or have had any of the following conditions in the past. Huntington's disease |
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QID1_26 | Please indicate whether you currently have or have had any of the following conditions in the past. Amyotrophic lateral sclerosis (ALS) |
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QID33 | Have you been diagnosed with human immunodeficiency virus (HIV)? |
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QID9 | Please indicate whether you currently have or had experienced alcohol abuse in the past |
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QID13 | How long did you experience the alcohol abuse in years? |
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QID15 | How long has it been in years since you stopped the alcohol abuse? If you still abuse alcohol please write 0 |
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QID16 | Please write the average number of drinks you would have on a typical day during the period when you abused alcohol (1 drink would equal either 4 oz of wine, 12 ounces beer or 1 oz of liquor) Please only write the number of drinks |
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QID17 | Please indicate whether you currently have or had experienced drug abuse in the past |
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QID18 | How long did you experience the drug abuse in years? |
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QID19 | How long has it been in years since you stopped the drug abuse? If you still abuse drugs please write 0 |
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QID20 | Please indicate whether you currently smoke tobacco or have smoked tobacco in the past |
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QID21 | How long did you smoke tobacco, in years? |
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QID22 | How long has it been in years since you stopped smoking tobacco? If you still smoke please write 0 |
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QID23 | Please write the average number of cigarettes you would have on a typical day during the period when you smoked |
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QID2 | Is chronic pain a problem for you? |
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QID3_1 | Please indicate how severe your pain is from 1-10 (10 is the most severe) Severity of Pain |
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QID4 | Have you ever been diagnosed with sleep apnea? |
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QID6 | Do you have allergies? |
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QID28#1_1 | Past or Current Major Depressive Disorder |
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QID28#1_3 | Past or Current Specific Phobia / Social Phobia |
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QID28#1_4 | Past or Current Obsessive Compulsive Disorder |
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QID28#1_5 | Past or Current Hoarding Disorder |
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QID28#1_6 | Past or Current Attention-Deficit / Hyperactivity Disorder |
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QID28#1_8 | Past or Current Post-Traumatic Stress Disorder |
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QID28#1_9 | Past or Current Generalized Anxiety Disorder |
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QID28#1_10 | Past or Current Panic Disorder |
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QID28#1_11 | Past or Current Bipolar Disorder |
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QID28#1_12 | Past or Current Autism |
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QID28#1_13 | Past or Current Schizophrenia |
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QID28#1_14 | Past or Current Eating Disorder |
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QID28#1_15 | Past or Current Psychosis |
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QID30_1 | Do you currently have... A cardiac pacemaker/defibrillator? |
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Column Name | Question Text | Codes |
---|---|---|
QID141 | During the past month, when have you usually gone to bed at night? |
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QID142 | During the past month, how long (in minutes) has it usually taken you to fall asleep each night? |
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QID143 | During the past month, when have you usually gotten up in the morning? |
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QID94 | During the past month, how many hours of actual sleep did you get at night? (This may be different than the number of hours you spend in bed.) |
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QID95_1 | During the past month, how often have you had trouble sleeping because you... Cannot get to sleep within 30 minutes |
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QID95_2 | During the past month, how often have you had trouble sleeping because you... Wake up in the middle of the night or early morning |
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QID95_3 | During the past month, how often have you had trouble sleeping because you... Have to get up to use the bathroom |
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QID95_4 | During the past month, how often have you had trouble sleeping because you... Cannot breathe comfortably |
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QID95_5 | During the past month, how often have you had trouble sleeping because you... Cough or snore loudly |
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QID95_6 | During the past month, how often have you had trouble sleeping because you... Feel too cold |
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QID95_7 | During the past month, how often have you had trouble sleeping because you... Feel too hot |
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QID95_8 | During the past month, how often have you had trouble sleeping because you... Had bad dreams |
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QID95_9 | During the past month, how often have you had trouble sleeping because you... Have pain |
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QID95_10_TEXT | During the past month, how often have you had trouble sleeping because you... Other reason(s), please describe |
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QID96 | During the past month, how would you rate your sleep quality overall? |
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QID97 | During the past month, how often have you taken medicine (prescribed or "over the counter") to help you sleep? |
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QID98 | During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity? |
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QID145 | During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done? |
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QID146 | Do you have a bed partner or roommate? |
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QID101_1 | If you have a roommate or bed partner, ask him/her how often in the past month you have had... Loud snoring |
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QID101_2 | If you have a roommate or bed partner, ask him/her how often in the past month you have had... Long pauses between breaths while asleep |
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QID101_3 | If you have a roommate or bed partner, ask him/her how often in the past month you have had... Legs twitching or jerking while you sleep |
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QID101_4 | If you have a roommate or bed partner, ask him/her how often in the past month you have had... Episodes of disorientation or confusion during sleep |
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QID101_5_TEXT | If you have a roommate or bed partner, ask him/her how often in the past month you have had... Other restlessness while you sleep; please describe |
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QID196 | How many hours do you spend napping in a typical day? |
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QID197 | I feel sleepy during the day and struggle to remain alert. |
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Column Name | Question Text | Codes |
---|---|---|
QID56 | Are you basically satisfied with your life? |
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QID57 | Have you dropped many of your activities and interests? |
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QID58 | Do you feel that your life is empty? |
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QID59 | Do you often get bored? |
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QID60 | Are you in good spirits most of the time? |
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QID61 | Are you afraid that something bad is going to happen to you? |
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QID62 | Do you feel happy most of the time? |
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QID63 | Do you often feel helpless? |
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QID64 | Do you prefer to stay at home, rather than going out and doing new things? |
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QID65 | Do you feel you have more problems with memory than most? |
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QID66 | Do you think it's wonderful to be alive now? |
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QID67 | Do you feel pretty worthless the way you are now? |
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QID68 | Do you feel full of energy? |
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QID69 | Do you feel that your situation is hopeless? |
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QID70 | Do you think that most people are better off than you are? |
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QID197_1 | Over the last 2 weeks, how often have you been bothered by any of the following problems? Read each item carefully, and select your response. a. Little interest or pleasure in doing things |
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QID197_2 | Over the last 2 weeks, how often have you been bothered by any of the following problems? Read each item carefully, and select your response. b. Feeling down, depressed, or hopeless |
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QID197_3 | Over the last 2 weeks, how often have you been bothered by any of the following problems? Read each item carefully, and select your response. c. Trouble falling asleep, staying asleep, or sleeping too much |
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QID197_4 | Over the last 2 weeks, how often have you been bothered by any of the following problems? Read each item carefully, and select your response. d. Feeling tired or having little energy |
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QID197_5 | Over the last 2 weeks, how often have you been bothered by any of the following problems? Read each item carefully, and select your response. e. Poor appetite or overeating |
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QID197_6 | Over the last 2 weeks, how often have you been bothered by any of the following problems? Read each item carefully, and select your response. f. Feeling bad about yourself, feeling that you are a failure, or feeling that you have let yourself or your family down |
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QID197_7 | Over the last 2 weeks, how often have you been bothered by any of the following problems? Read each item carefully, and select your response. g. Trouble concentrating on things such as reading the newspaper or watching television |
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QID197_8 | Over the last 2 weeks, how often have you been bothered by any of the following problems? Read each item carefully, and select your response. h. Moving or speaking so slowly that other people could have noticed. Or being so fidgety or restless that you have been moving around a lot more than usual |
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QID198 | If you selected any of the above problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? |
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Column Name | Question Text | Codes |
---|---|---|
QID197 | Are you known to carry a genetic mutation (PS1/PS2 or APP) that causes early onset Alzheimer's disease? |
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QID198 | Do you have a family member (parent, grandparent, sibling, or child) who is known to carry a genetic mutation (PS1/PS2 or APP) that causes early onset Alzheimer's disease? |
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QID199 | Did you begin to experience symptoms of Alzheimer's disease before age 60? |
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QID200 | Do you have a family member (parent, grandparent, sibling, or child) who began to experience symptoms of Alzheimer's disease before age 60? |
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QID201 | Are you known to be a carrier of an e4 allele of the apolipoprotein E (APOE) gene, which increases an individual's risk for developing late-onset Alzheimer disease? |
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QID202 | Do you have a family member (parent, grandparent, sibling, or child) who is known to be a carrier of an e4 allele of the apolipoprotein E (APOE) gene, which increases an individual's risk for developing late-onset Alzheimer disease? |
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Column Name | Question Text - In the last month: | Codes |
---|---|---|
QID4 | Have you, your sibling(s), or parent(s) been diagnosed with Alzheimer's Disease? |
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QID2 | Are you concerned that you have a memory problem? |
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QID3 | Do you have trouble remembering if you have already told someone something? |
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QID5 | Would you say there has been a change in your memory? |
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QID5 | Have you had a head injury in the last month? |
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QID20 | In general, would you say your health is: |
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QID7 | How would you rate your health in general? |
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QID8 | Are you in good spirits most of the time? |
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QID21 | Have you dropped many of your activities and interests? |
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QID10 | During the past month, did you experience any sleep problems? |
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QID11 | During the past month, did you take any sleep medications? |
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QID22 | During the past month, have you consumed alcoholic beverages? |
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QID15_1 | Are you currently taking any of the following types of medications? (Select all that apply) Anti-depressant medication; Anti-anxiety medication; Anti-psychotic medication; Medications for your memory |
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