World Parkinson's Disease Society New MDS-UPDRS Comprehensive Assessment Scale - <span style="font-size: 16px;color: #f60">Patient Self-Assessment Section</span>

World Parkinson's Disease Society New MDS-UPDRS Comprehensive Assessment Scale - Patient Self-Assessment Section

Instructions:

● This questionnaire will ask you some questions about your daily life. This questionnaire contains a total of 20 questions. To be as thorough as possible, the questionnaire may include some questions that you currently or up until now have not experienced. If you do not have these problems, please select "0" to indicate that there are no problems.

● Please read each question carefully and select the answer that best suits you after reading all the options. What we want to know is your average or general functional status over the past week, including today. Although you may be more active at certain times of the day than at others, each question can only have one answer. Therefore, please select the answer that best describes your condition most of the time.

● In addition to Parkinson's disease, you may have other diseases. However, you do not need to distinguish between the symptoms caused by Parkinson's disease and those caused by other diseases.

● Please select the answer that suits you best, and do not leave any options blank.

● Your doctor or nurse can review these questions with you, but this questionnaire must be completed by the patient themselves or together with their caregiver.

Important Note: This questionnaire is only the self-assessment section for the patient and is not the complete MDS-UPDRS scoring. After completing this questionnaire, please show the score (screenshot) to your doctor during your appointment to assist the doctor in completing the entire MDS-UPDRS scoring.

Patient Name

Part I: Non-Motor Symptoms in Daily Life (nM-EDL)

1.7 Sleep Problems

During the past week, did you have difficulty falling asleep at night or difficulty maintaining continuous sleep throughout the night? How did you feel upon waking up in the morning?

Normal: No sleep problems.

Mild: There are sleep problems, but I can usually sleep through the night.

Moderate: There are sleep problems, and sometimes I cannot maintain sleep throughout the night.

Moderate: There are sleep problems, and it is difficult to maintain sleep throughout the night, but I usually can sleep most of the time.

Severe: I usually cannot sleep most of the night.

1.8 Daytime Sleepiness

During the past week, did you have difficulty staying awake during the day?

Normal: No daytime sleepiness.

Mild: There are instances of feeling sleepy during the day, but I can resist and stay awake.

Moderate: Sometimes I fall asleep when I am alone and relaxed, for example, while reading or watching TV.

Moderate: Sometimes I fall asleep when I shouldn't, for example, while eating or talking with someone.

Severe: I often fall asleep when I shouldn't, for example, while eating or talking with someone.

1.9 Pain and Other Sensations

In the past week, have you felt any physical discomfort, such as pain, tingling, or cramping?

Normal: No discomfort

Mild: I have discomfort, but I can do my activities and socialize without difficulty.

Moderate: This discomfort causes some trouble when doing activities or socializing.

Severe: This discomfort causes significant trouble, but I can still do my activities or socialize.

Extreme: This discomfort prevents me from doing activities or socializing.

1.10 Urination Problems

In the past week, have you had difficulty controlling urination? For example, urgency, frequency, or incontinence?

Normal: No urination problems.

Mild: I have frequency or urgency, but it does not affect my daily activities.

Moderate: Urination problems affect my daily activities somewhat, but I do not have incontinence.

Severe: Urination problems significantly impact my daily activities, including incontinence.

Extreme: I cannot control urination and need to use pads or have a catheter.

1.11 Constipation Problems

In the past week, have you had constipation that has caused difficulty in bowel movements?

Normal: No constipation

Mild: I have constipation. I need extra effort to pass stools, but this does not interfere with my life or cause discomfort.

Moderate: Constipation causes some trouble in my life or discomfort.

Severe: Constipation causes significant trouble in my life or discomfort, but I can still manage.

Extreme: I usually need assistance from others to pass stools.

1.12 Dizziness When Standing

In the past week, have you felt dizzy or lightheaded when standing up from a sitting or lying position?

Normal: No dizziness or lightheadedness

Mild: I have experienced dizziness or lightheadedness, but it does not affect my activities.

Moderate: Dizziness or lightheadedness makes me need to hold onto something when standing, but I do not need to sit or lie down.

Severe: Dizziness or lightheadedness makes me need to sit or lie down to avoid fainting or falling.

Extreme: Dizziness or lightheadedness often makes me unable to stand up without assistance.

1.13 Other Health Issues

In the past week, have you experienced any other health problems or concerns?

Normal: No health problems

Mild: I have had some health concerns, but they do not affect my daily life.

Moderate: I have health issues that affect my daily life somewhat.

Severe: My health issues significantly interfere with my daily activities.

Extreme: I cannot manage my health issues without help from others.

Part Two: Movement Symptoms in Daily Life (M-EDL)

2.1 Speech

In the past week, have you had any problems with speaking?

Normal: No issues.

Mild: I speak softly, unclearly, or not fluently, but others do not need me to repeat.

Moderate: Others occasionally need me to repeat what I said, but not every day.

Severe: I speak unclearly, so every day someone asks me to repeat, but they mostly understand.

Extreme: Most of the time, others cannot understand me at all.

2.2 Saliva and Drooling

In the past week, have you usually experienced excessive saliva while awake or sleeping?

Normal: No issues.

Mild: I have increased saliva, but I do not drool.

Moderate: I drool while sleeping, but not while awake.

Severe: I sometimes drool while awake, but usually do not need tissues or handkerchiefs to wipe.

Extreme: I have so much saliva that I often need tissues or handkerchiefs to avoid soiling my clothes.

2.3 Chewing and Swallowing

In the past week, have you usually had problems taking pills or eating? Do you need to crush or grind medications, or prepare food as soft, chopped, or blended to eat without choking?

Normal: No issues.

Mild: I know that I chew slowly or have some difficulty swallowing, but I do not choke, and food does not require special preparation.

Moderate: Due to chewing or swallowing issues, my pills need to be crushed or my food requires special preparation, but I have not choked in the past week.

Severe: In the past week, I have choked at least once.

Extreme: Due to chewing and swallowing issues, I require a nasogastric diet.

2.4 Eating

In the past week, have you usually had difficulties with eating and using utensils? For example, do you have trouble picking up food with your hands or using a knife, fork, spoon, or chopsticks?

Normal: No issues.

Mild: I eat slowly, but I do not need help, and food does not spill while eating.

Moderate: I eat slowly, and occasionally food spills. I sometimes need help preparing food, like cutting meat.

Severe: I often need help while eating, but I can still do some things independently.

Extreme: I need help most or all of the time while eating.

2.5 Dressing

In the past week, have you usually had difficulties dressing? For example, do you dress slowly or need help with buttons, zippers, or putting on/taking off clothes or jewelry?

Normal: No issues.

Mild: I move slowly but do not need help.

Moderate: I move slowly and occasionally need help (like with buttons, putting on bracelets).

Severe: I need help in many situations.

Extreme: I need help most or all of the time while dressing.

2.6 Personal Hygiene

In the past week, have you often felt slow or needed help with personal hygiene tasks such as washing, bathing, shaving, brushing teeth, or combing hair?

Normal: No issues.

Mild: I need help with some personal hygiene tasks.

Moderate: I need help with many personal hygiene tasks.

Severe: I need help from others for most or all of my personal hygiene.

2.7 Writing

In the past week, have others often found your handwriting difficult to read?

Normal: No problems.

Mild: I write slowly, awkwardly, or untidily, but all my writing is clearly readable.

Mild: Some of my letters are unclear and hard to read.

Moderate: Many of my letters are unclear and hard to read.

Severe: Most or all of my writing is unreadable.

2.8 Hobbies and Other Activities

In the past week, have you usually had difficulty doing things you enjoy or hobbies?

Normal: No problems.

Mild: My movements are a bit slow, but I can still easily do these activities.

Mild: I have some difficulty doing these activities.

Moderate: I have great difficulty doing these activities, but I still do them often.

Severe: I can no longer do them or do them very rarely.

2.9 Turning in Bed

In the past week, have you often had difficulty turning over in bed?

Normal: No problems.

Mild: I have a bit of difficulty turning, but I do not need help.

Mild: I find it difficult to turn and occasionally need help from others.

Moderate: I often need help from others to turn.

Severe: I cannot turn at all without help from others.

2.10 Tremors

In the past week, have you often experienced shaking or tremors?

Normal: I do not have shaking or tremors.

Mild: I have shaking or tremors, but they do not affect my activities.

Moderate: The shaking or tremors only affect a few of my activities.

Severe: The shaking or tremors affect many of my activities.

Very Severe: The shaking or tremors affect most or all of my activities.

2.11 Getting Up, Getting Out, or Standing Up from a Low Chair

In the past week, have you often felt difficulty getting up, getting out, or standing up from a low chair?

Normal: No problems.

Mild: I move slowly or clumsily, but I can usually do it in one go.

Moderate: I need to try more than once to complete it, or I occasionally need help.

Significant: Sometimes I need help to complete it, but most of the time I can do it myself.

Severe: I mostly or completely need someone else's help.

2.12 Walking and Balance

In the past week, have you often had difficulties walking and maintaining balance?

Normal: No problems.

Mild: I am slightly slow or might drag my feet, but I do not need a walker.

Moderate: I occasionally need a walker, but I do not need help from others.

Significant: I usually need to use a walker (cane, walker) to prevent falls, but I do not often need help from others.

Severe: I usually need someone else's help to walk to prevent falls.

2.13 Freezing

In the past week, have you experienced a sudden freezing or feeling as if your feet are stuck to the ground while walking?

Normal: No problems.

Mild: I have brief freezing but can easily start walking again. I do not need help from others or a walker (cane or walker) because of freezing.

Moderate: I freeze while walking and have difficulty starting again, but I do not need help from others or a walker (cane or walker).

Significant: It is difficult for me to start walking again when I freeze. I sometimes need a walker or help from others due to freezing.

Severe: Due to freezing, I need a walker or help from others most or all of the time.

Patient Name:

Part I【Non-Motor Symptom Patient Questionnaire (1.7~1.13)】Total Score 0 points

Part II【Motor Symptoms in Daily Life (M-EDL)】Total Score 0 points

Tip: Please take a screenshot of the results and tell your doctor about these results.

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