PDQ-39 QUESTIONNAIRE - viartis.net

1 Page 3 of 12 Questionnaires for patient completionPlease complete the followingPlease tick onebox for each questionDue to having Parkinson s disease,how often during the last monthhave Occasionally Sometimes Often Always1 Had difficulty doingthe leisure activities whichyou would like to do?2 Had difficulty looking afteryour home, DIY,housework, cooking?3 Had difficulty carrying bagsof shopping?4 Had problems walking halfa mile?5 Had problems walking 100yards?6 Had problems gettingaround the house as easilyas you would like?7 Had difficulty gettingaround in public?8 Needed someone else toaccompany you when youwent out?9 Felt frightened or worriedabout falling over inpublic?10 Been confined to thehouse more than youwould like?11 Had difficulty washingyourself?12 Had difficulty dressingyourself?13 Had problems doing upyour shoe laces?

2 Please check that you have ticked one box for each questionbefore going on to the next pagePDQ-39 QUESTIONNAIREor cannot doat allPage 4 of 12 Questionnaires for patient completionPlease tick onebox for each questionDue to having Parkinson s disease,how often during the last monthhave Occasionally Sometimes Often Always14 Had problems writingclearly?15 Had difficulty cutting upyour food?16 Had difficulty holding adrink without spilling it?17 Felt depressed?18 Felt isolated and lonely?19 Felt weepy or tearful?20 Felt angry or bitter?21 Felt anxious?22 Felt worried about yourfuture?23 Felt you had to concealyour Parkinson's frompeople?24 Avoided situations whichinvolve eating or drinkingin public?25 Felt embarrassed in publicdue to having Parkinson'sdisease?26 Felt worried by otherpeople's reaction to you?27 Had problems with yourclose personalrelationships?

3 28 Lacked support in theways you need from yourspouse or partner?If you do not have a spouse orpartner tick here29 Lacked support in theways you need from yourfamily or close friends?Please check that you have ticked one box for each questionbefore going on to the next pageor cannot doat allPage 5 of 12 Questionnaires for patient completionDue to having Parkinson s disease,how often during the last monthhave Occasionally Sometimes Often Always30 Unexpectedly fallen asleepduring the day?31 Had problems with yourconcentration, whenreading or watching TV?32 Felt your memory wasbad?33 Had distressing dreams orhallucinations?34 Had difficulty with yourspeech?35 Felt unable tocommunicate with peopleproperly?36 Felt ignored by people?37 Had painful musclecramps or spasms?38 Had aches and pains inyour joints or body?

4 39 Felt unpleasantly hot orcold?Please check that you have ticked one box for each questionbefore going on to the next pageThank you for completing the pdq 39 QUESTIONNAIRE Please tick onebox for each questio