Non motor Parkinson's questionnaire

Please visit the Parkinson's UK website for some amazing resources and information : http://www.parkinsons.org.uk/

The website provides links to a plethora of resources.One useful resource for the GP is the form below, however, there are more resources available for all hgealthcare professionals involved in your care.

http://www.parkinsons.org.uk/content/health-and-social-care-professionals

 

 

 

A guide to using the non-motor symptoms questionnaire

 

http://www.parkinsons.org.uk/sites/default/files/publications/download/english/nms_questionnaire.pdf

The non-motor symptoms questionnaire is a 30-point, patient-based questionnaire used to determine the non-motor symptoms experienced by the patient during the past month.

The questionnaire takes approximately five minutes to complete.

  • If the patient has a carer they should be encouraged to help fill in the questionnaire.
  1. The patient may need to ask the neurologist or Parkinson's nurse for help to complete if their carer is not able to.
  1. The questionnaire should be completed when the patient is waiting to be reviewed in clinic by the neurologist or Parkinson's nurse, as recommended by the NICE guidelines and Parkinson’s UK.
  1. The points should be totalled to give a score out of 30. A score of under 10 is mild, 10-20 moderate and over 20, severe.
  1. The patient should be asked to list the three most troublesome problems to be discussed with the neurologist or Parkinson's nurse, in order of priority.

Further clarification should be sought on the following points if necessary:

  • Question 2: Loss or change in your ability to taste or smell – specify which one or both.
  1. Question 11: Unexplained change in weight (not due to change in diet) – specify how the weight has changed (increase or decrease).
  1. Question 18: Feeling less interested in sex or more interested in sex – circle which one.
  1. Question 23: Difficulty getting to sleep at night or staying asleep at night – specify which one.

© Parkinson’s UK, May 2013. Parkinson’s UK is the operating name of the Parkinson’s Disease Society of the United Kingdom. A charity registered in England and Wales (258197) and in Scotland (SC037554).

 

Non-motor symptoms questionnaire

Name:..............................................................................................Date:......................................................................Age:......................................

Centre ID: Male Female

Have you experienced any of the following in the last month?

All the information you supply through this form will be treated with confidence and will only be used for the purpose for which it has been collected. Information supplied will be used for monitoring purposes. Your personal data will be processed and held in accordance with the Data Protection Act 1998. Developed and validated by the International PD Non Motor Group.

Non-movement problems in Parkinson’s

The movement symptoms of Parkinson’s are well known. However, other problems can sometimes occur as part of the condition or its treatment. It is important that the doctor knows about these, particularly if they are troublesome for you.

A range of problems is listed below. Please tick the box ‘Yes’ if you have experienced it during the past month. The doctor or nurse may ask you some questions to help decide. If you have not experienced the problem in the past month tick the ‘No’ box. You should answer ‘No’ even if you have had the problem in the past but not in the past month.

This questionnaire should be completed and given to your GP, specialist or Parkinson’s nurse at your next appointment. Please do not return it to Parkinson’s UK. Thank you.

Yes

No

1 Dribbling of saliva during the daytime.

2 Loss or change in your ability to taste or smell.

3 Difficulty swallowing food or drink or problems with choking.

4 Vomiting or feelings of sickness (nausea).

5 Constipation (less than three bowel movements a week) or having to strain to pass a stool.

6 Bowel (faecal) incontinence.

7 Feeling that your bowel emptying is incomplete after having been to the toilet.

8 A sense of urgency to pass urine makes you rush to the toilet.

9 Getting up regularly at night to pass urine.

10 Unexplained pains (not due to known conditions such as arthritis).