Symptom | Score | |||||
---|---|---|---|---|---|---|
The following applies to my tremor: | ||||||
The following applies to my dyskinesia: | ||||||
The following applies to my daily off time: | ||||||
The following applies to my concentration: | ||||||
The following applies to my urinary / urinary urge frequency: | ||||||
The following applies to my pain: | ||||||
I have had slow movements: | ||||||
I have felt depressed: | ||||||
I have felt anxious: | ||||||
I have felt fatigue: | ||||||
I have felt unmotivated or lack of desire for my daily activities: | ||||||
I have had one or more episodes of dystonia (such as toe or finger curling or twisting): | ||||||
How much (percentage) of the waking day yesterday did you feel off… | ||||||
Did you feel ‘off’? (wearing off or lack of response to Parkinson medication) | Score | |||||
0% | 1–10% | 11–25% | 26–50% | 51–75% | 76% or greater | |
1 | 2 | 3 | 4 | 5 | 6 |