| Demographic Data |
| Relation to Proband |
father |
| Age at Sampling |
45 YR |
| Sex |
Male |
| 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 |
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 |
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: MOTHER |
| Dementia |
Alzheimer's
Dementia
absent
|
| Depression |
present absent |
| Diabetes |
present absent |
| Dystonia |
present absent |
| Epilepsy |
present absent
Notes: DAUGHTER |
| Heart disease |
present absent |
| Hypertension |
present absent |
| memory loss |
present absent |
| Migraine |
present absent
Notes: MOTHER |
| 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 |
No Data |