| Demographic Data |
| Relation to Proband |
No Data |
| Age at Sampling |
53 YR |
| Sex |
Male |
| Age of Onset(If not a control) |
50 YR |
| Age at Diagnosis(If not a control) |
53 YR |
| Hispanic or Latino/Not Hispanic or Latino |
Not Hispanic/Latino |
| Racial Category |
White |
| 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) |
| 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 |
29 |
| Hoehn and Yahr |
No Data |
| UPDRS total motor score |
No Data |
| Handedness |
Right Left Ambidextrous |