English

CRF Cognition Module Baseline

1 forms  
Anamnesis cognition 1: Subjective cognitive decline
Description

Anamnesis cognition 1: Subjective cognitive decline

1. Did your memory changed for the worse?
Description

Structured interview about cognitive disorders. All questions need to be asked using original wording. The physician aks follow-up questions for every question that was affirmed by the participant. -> Now I want to aks you some question, to understand the sort of complaints correctly:

Data type

boolean

Alias
UMLS CUI [1]
C0233794
A. If 'yes', does this make you worry?
Description

memory impairment worry

Data type

boolean

Alias
UMLS CUI [1,1]
C0233794
UMLS CUI [1,2]
C0233481
B. If 'yes', when did deterioration start?
Description

memory impairment onset

Data type

integer

Alias
UMLS CUI [1,1]
C0233794
UMLS CUI [1,2]
C0868945
UMLS CUI [1,3]
C0332162
C. If 'yes', is your ability in this section worse than of other persons your age?
Description

memory impairment age

Data type

boolean

Alias
UMLS CUI [1,1]
C0233794
UMLS CUI [1,2]
C1707455
UMLS CUI [1,3]
C0027362
D. If 'yes', have you ever consulted or talked to your doctor about these problems?
Description

memory impairment consult

Data type

boolean

Alias
UMLS CUI [1,1]
C0233794
UMLS CUI [1,2]
C3693724
E. If 'yes', when for the first time?
Description

memory impairment consult time

Data type

integer

Measurement units
  • months
Alias
UMLS CUI [1,1]
C0233794
UMLS CUI [1,2]
C3693724
months
2. Do you have to grope for words more often than before?
Description

word finding

Data type

boolean

Alias
UMLS CUI [1]
C0454643
A. If 'yes', does this make you worry?
Description

word finding worry

Data type

boolean

Alias
UMLS CUI [1,1]
C0454643
UMLS CUI [1,2]
C0233481
B. If 'yes', when did deterioration start?
Description

word finding onset

Data type

integer

Alias
UMLS CUI [1,1]
C0454643
UMLS CUI [1,2]
C0868945
UMLS CUI [1,3]
C0332162
C. If 'yes', is your ability in this section worse than of other persons your age?
Description

word finding age

Data type

boolean

Alias
UMLS CUI [1,1]
C0454643
UMLS CUI [1,2]
C1707455
UMLS CUI [1,3]
C0027362
D. If 'yes', have you ever consulted or talked to your doctor about these problems?
Description

word finding consult

Data type

boolean

Alias
UMLS CUI [1,1]
C0454643
UMLS CUI [1,2]
C3693724
E. If 'yes', when for the first time?
Description

word finding consult time

Data type

integer

Measurement units
  • months
Alias
UMLS CUI [1,1]
C0454643
UMLS CUI [1,2]
C3693724
months
3. Do you have more often problems planning forward-thinking or keeping order?
Description

problems planning

Data type

boolean

Alias
UMLS CUI [1]
C0423907
A. If 'yes', does this make you worry?
Description

problems planning worry

Data type

boolean

Alias
UMLS CUI [1,1]
C0423907
UMLS CUI [1,2]
C0233481
B. If 'yes', when did deterioration start?
Description

problems planning onset

Data type

integer

Alias
UMLS CUI [1,1]
C0423907
UMLS CUI [1,2]
C0868945
UMLS CUI [1,3]
C0332162
C. If 'yes', is your ability in this section worse than of other persons your age?
Description

problems planning age

Data type

boolean

Alias
UMLS CUI [1,1]
C0423907
UMLS CUI [1,2]
C1707455
UMLS CUI [1,3]
C0027362
D. If 'yes', have you ever consulted or talked to your doctor about these problems?
Description

problems planning consult

Data type

boolean

Alias
UMLS CUI [1,1]
C0423907
UMLS CUI [1,2]
C3693724
E. If 'yes', when for the first time?
Description

problems planning consult time

Data type

integer

Measurement units
  • months
months
4. Do you make mistakes more frequently, if you not fully concentrate on one thing?
Description

making mistakes

Data type

boolean

Alias
UMLS CUI [1]
C1821936
A. If 'yes', does this make you worry?
Description

making mistakes worry

Data type

boolean

Alias
UMLS CUI [1,1]
C1821936
UMLS CUI [1,2]
C0233481
B. If 'yes', when did deterioration start?
Description

making mistakes onset

Data type

integer

Alias
UMLS CUI [1,1]
C1821936
UMLS CUI [1,2]
C0868945
UMLS CUI [1,3]
C0332162
C. If 'yes', is your ability in this section worse than of other persons your age?
Description

making mistakes age

Data type

boolean

Alias
UMLS CUI [1,1]
C1821936
UMLS CUI [1,2]
C1707455
UMLS CUI [1,3]
C0027362
D. If 'yes', have you ever consulted or talked to your doctor about these problems?
Description

making mistakes consult

Data type

boolean

Alias
UMLS CUI [1,1]
C1821936
UMLS CUI [1,2]
C3693724
E. If 'yes', when for the first time?
Description

making mistakes consult time

Data type

integer

Measurement units
  • months
Alias
UMLS CUI [1,1]
C1821936
UMLS CUI [1,2]
C3693724
months
5. Did you notice any other mental deterioration? In which sections?
Description

other mental deterioation

Data type

boolean

Alias
UMLS CUI [1,1]
C0234985
UMLS CUI [1,2]
C0205394
Other mental deterioation:
Description

other mental deterioation name

Data type

text

Alias
UMLS CUI [1,1]
C0234985
UMLS CUI [1,2]
C0205394
A. If 'yes', does this make you worry?
Description

other mental deterioation worry

Data type

boolean

Alias
UMLS CUI [1,1]
C0234985
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C0233481
B. If 'yes', when did deterioration start?
Description

other mental deterioation onset

Data type

integer

Alias
UMLS CUI [1,1]
C0234985
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C0868945
UMLS CUI [1,4]
C0332162
C. If 'yes', is your ability in this section worse than of other persons your age?
Description

other mental deterioation age

Data type

boolean

Alias
UMLS CUI [1,1]
C0234985
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C1707455
UMLS CUI [1,4]
C0027362
D. If 'yes', have you ever consulted or talked to your doctor about these problems?
Description

other mental deterioation consult

Data type

boolean

Alias
UMLS CUI [1,1]
C0234985
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C3693724
E. If 'yes', when for the first time?
Description

other mental deterioation consult time

Data type

integer

Measurement units
  • months
Alias
UMLS CUI [1,1]
C0234985
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C3693724
months
Anamnesis cognition 2: Observed cognitive decline
Description

Anamnesis cognition 2: Observed cognitive decline

Presence of informant (Questions may be asked while participant is present)
Description

Quetions for informant

Data type

text

Alias
UMLS CUI [1]
C3842888
Informations are reported by: (only one answer)
Description

informant

Data type

text

Alias
UMLS CUI [1]
C1550484
1. Did the memory of the participant change for the worse?
Description

All questions need to be ask using original wording. Please answer for each main question answered with 'yes' for onset.

Data type

boolean

Alias
UMLS CUI [1]
C0233794
Start of deterioation:
Description

memory impairment onset informant

Data type

integer

Alias
UMLS CUI [1,1]
C0233794
UMLS CUI [1,2]
C0868945
UMLS CUI [1,3]
C0332162
2. Does the participant have frequently problems finding words?
Description

word finding informant

Data type

boolean

Alias
UMLS CUI [1]
C0454643
Start of deterioation:
Description

word finding onset informant

Data type

integer

Alias
UMLS CUI [1,1]
C0454643
UMLS CUI [1,2]
C0868945
UMLS CUI [1,3]
C0332162
3. Does the participant have more often problems planning forward-thinking or keeping order?
Description

problems planning informant

Data type

boolean

Alias
UMLS CUI [1]
C0423907
Start of deterioation:
Description

problems planning onset informant

Data type

integer

Alias
UMLS CUI [1,1]
C0423907
UMLS CUI [1,2]
C0868945
UMLS CUI [1,3]
C0332162
4. Does the participant make mistakes more frequently, if he not fully concentrates on one thing?
Description

making mistakes informant

Data type

boolean

Alias
UMLS CUI [1]
C1821936
Start of deterioation:
Description

making mistakes onset informant

Data type

integer

Alias
UMLS CUI [1,1]
C1821936
UMLS CUI [1,2]
C0868945
UMLS CUI [1,3]
C0332162
5. Did you notice any other mental deterioration? In which sections?
Description

other mental deterioation informant

Data type

boolean

Alias
UMLS CUI [1,1]
C0234985
UMLS CUI [1,2]
C0205394
Other mental deterioation:
Description

other mental deterioation name informant

Data type

text

Alias
UMLS CUI [1,1]
C0234985
UMLS CUI [1,2]
C0205394
Start of deterioation:
Description

other mental deterioation onset informant

Data type

integer

Alias
UMLS CUI [1,1]
C0234985
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C0868945
UMLS CUI [1,4]
C0332162
6. Did you notice a change of behavior or personality of the participant?
Description

personality change

Data type

boolean

Alias
UMLS CUI [1]
C0240735
Start of change:
Description

personality change onset

Data type

integer

Alias
UMLS CUI [1,1]
C0240735
UMLS CUI [1,2]
C0868945
UMLS CUI [1,3]
C0332162
Mini mental state examination (MMSE)
Description

Mini mental state examination (MMSE)

1. Orientation 1.1. Orientation in time
Description

Number of correct answers

Data type

integer

Alias
UMLS CUI [1]
C0451306
UMLS CUI [2]
C0599544
1.2. Orientation to place
Description

Number of correct answers

Data type

integer

Alias
UMLS CUI [1]
C0451306
UMLS CUI [2]
C2370999
2. Retention in memory
Description

Number of correct answers

Data type

integer

Alias
UMLS CUI [1]
C0451306
UMLS CUI [2]
C0598851
3. Attention
Description

Number of correct answers

Data type

integer

Alias
UMLS CUI [1]
C0451306
UMLS CUI [2]
C0004268
4. Powers of recollection
Description

Number of correct answers

Data type

integer

Alias
UMLS CUI [1]
C0451306
UMLS CUI [2]
C0025260
5. Speech
Description

Number of correct answers

Data type

integer

Alias
UMLS CUI [1]
C0451306
UMLS CUI [2]
C0037817
6. Drawing
Description

Number of correct answers

Data type

integer

Alias
UMLS CUI [1]
C0451306
UMLS CUI [2]
C0013113
total score MMSE
Description

total score MMSE

Data type

integer

Alias
UMLS CUI [1]
C2225229
Neuropsychologic testing
Description

Neuropsychologic testing

1. Do you have difficulties hearing?
Description

Orientating sensory evaluation

Data type

text

Alias
UMLS CUI [1]
C1313969
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Similar models

CRF Cognition Module Baseline

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Anamnesis cognition 1: Subjective cognitive decline
memory impairment
Item
1. Did your memory changed for the worse?
boolean
C0233794 (UMLS CUI [1])
memory impairment worry
Item
A. If 'yes', does this make you worry?
boolean
C0233794 (UMLS CUI [1,1])
C0233481 (UMLS CUI [1,2])
Item
B. If 'yes', when did deterioration start?
integer
C0233794 (UMLS CUI [1,1])
C0868945 (UMLS CUI [1,2])
C0332162 (UMLS CUI [1,3])
memory impairment onset
Code List
B. If 'yes', when did deterioration start?
CL Item
within the last six month (1)
CL Item
from six month ago on to two years ago (2)
CL Item
from two to five years ago (3)
CL Item
more than five years ago (4)
CL Item
not specified (5)
memory impairment age
Item
C. If 'yes', is your ability in this section worse than of other persons your age?
boolean
C0233794 (UMLS CUI [1,1])
C1707455 (UMLS CUI [1,2])
C0027362 (UMLS CUI [1,3])
memory impairment consult
Item
D. If 'yes', have you ever consulted or talked to your doctor about these problems?
boolean
C0233794 (UMLS CUI [1,1])
C3693724 (UMLS CUI [1,2])
memory impairment consult time
Item
E. If 'yes', when for the first time?
integer
C0233794 (UMLS CUI [1,1])
C3693724 (UMLS CUI [1,2])
word finding
Item
2. Do you have to grope for words more often than before?
boolean
C0454643 (UMLS CUI [1])
word finding worry
Item
A. If 'yes', does this make you worry?
boolean
C0454643 (UMLS CUI [1,1])
C0233481 (UMLS CUI [1,2])
Item
B. If 'yes', when did deterioration start?
integer
C0454643 (UMLS CUI [1,1])
C0868945 (UMLS CUI [1,2])
C0332162 (UMLS CUI [1,3])
memory impairment onset
Code List
B. If 'yes', when did deterioration start?
CL Item
within the last six month (1)
CL Item
from six month ago on to two years ago (2)
CL Item
from two to five years ago (3)
CL Item
more than five years ago (4)
CL Item
not specified (5)
word finding age
Item
C. If 'yes', is your ability in this section worse than of other persons your age?
boolean
C0454643 (UMLS CUI [1,1])
C1707455 (UMLS CUI [1,2])
C0027362 (UMLS CUI [1,3])
word finding consult
Item
D. If 'yes', have you ever consulted or talked to your doctor about these problems?
boolean
C0454643 (UMLS CUI [1,1])
C3693724 (UMLS CUI [1,2])
word finding consult time
Item
E. If 'yes', when for the first time?
integer
C0454643 (UMLS CUI [1,1])
C3693724 (UMLS CUI [1,2])
problems planning
Item
3. Do you have more often problems planning forward-thinking or keeping order?
boolean
C0423907 (UMLS CUI [1])
problems planning worry
Item
A. If 'yes', does this make you worry?
boolean
C0423907 (UMLS CUI [1,1])
C0233481 (UMLS CUI [1,2])
Item
B. If 'yes', when did deterioration start?
integer
C0423907 (UMLS CUI [1,1])
C0868945 (UMLS CUI [1,2])
C0332162 (UMLS CUI [1,3])
memory impairment onset
Code List
B. If 'yes', when did deterioration start?
CL Item
within the last six month (1)
CL Item
from six month ago on to two years ago (2)
CL Item
from two to five years ago (3)
CL Item
more than five years ago (4)
CL Item
not specified (5)
problems planning age
Item
C. If 'yes', is your ability in this section worse than of other persons your age?
boolean
C0423907 (UMLS CUI [1,1])
C1707455 (UMLS CUI [1,2])
C0027362 (UMLS CUI [1,3])
problems planning consult
Item
D. If 'yes', have you ever consulted or talked to your doctor about these problems?
boolean
C0423907 (UMLS CUI [1,1])
C3693724 (UMLS CUI [1,2])
problems planning consult time
Item
E. If 'yes', when for the first time?
integer
making mistakes
Item
4. Do you make mistakes more frequently, if you not fully concentrate on one thing?
boolean
C1821936 (UMLS CUI [1])
making mistakes worry
Item
A. If 'yes', does this make you worry?
boolean
C1821936 (UMLS CUI [1,1])
C0233481 (UMLS CUI [1,2])
Item
B. If 'yes', when did deterioration start?
integer
C1821936 (UMLS CUI [1,1])
C0868945 (UMLS CUI [1,2])
C0332162 (UMLS CUI [1,3])
memory impairment onset
Code List
B. If 'yes', when did deterioration start?
CL Item
within the last six month (1)
CL Item
from six month ago on to two years ago (2)
CL Item
from two to five years ago (3)
CL Item
more than five years ago (4)
CL Item
not specified (5)
making mistakes age
Item
C. If 'yes', is your ability in this section worse than of other persons your age?
boolean
C1821936 (UMLS CUI [1,1])
C1707455 (UMLS CUI [1,2])
C0027362 (UMLS CUI [1,3])
making mistakes consult
Item
D. If 'yes', have you ever consulted or talked to your doctor about these problems?
boolean
C1821936 (UMLS CUI [1,1])
C3693724 (UMLS CUI [1,2])
making mistakes consult time
Item
E. If 'yes', when for the first time?
integer
C1821936 (UMLS CUI [1,1])
C3693724 (UMLS CUI [1,2])
other mental deterioation
Item
5. Did you notice any other mental deterioration? In which sections?
boolean
C0234985 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
other mental deterioation name
Item
Other mental deterioation:
text
C0234985 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
other mental deterioation worry
Item
A. If 'yes', does this make you worry?
boolean
C0234985 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0233481 (UMLS CUI [1,3])
Item
B. If 'yes', when did deterioration start?
integer
C0234985 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0868945 (UMLS CUI [1,3])
C0332162 (UMLS CUI [1,4])
memory impairment onset
Code List
B. If 'yes', when did deterioration start?
CL Item
within the last six month (1)
CL Item
from six month ago on to two years ago (2)
CL Item
from two to five years ago (3)
CL Item
more than five years ago (4)
CL Item
not specified (5)
other mental deterioation age
Item
C. If 'yes', is your ability in this section worse than of other persons your age?
boolean
C0234985 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C1707455 (UMLS CUI [1,3])
C0027362 (UMLS CUI [1,4])
other mental deterioation consult
Item
D. If 'yes', have you ever consulted or talked to your doctor about these problems?
boolean
C0234985 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C3693724 (UMLS CUI [1,3])
other mental deterioation consult time
Item
E. If 'yes', when for the first time?
integer
C0234985 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C3693724 (UMLS CUI [1,3])
Item Group
Anamnesis cognition 2: Observed cognitive decline
Item
Presence of informant (Questions may be asked while participant is present)
text
C3842888 (UMLS CUI [1])
presence of informant
Code List
Presence of informant (Questions may be asked while participant is present)
CL Item
no informant present (no informant present)
CL Item
participant refuses interview with relative (participant refuses interview with relative)
Item
Informations are reported by: (only one answer)
text
C1550484 (UMLS CUI [1])
informant
Code List
Informations are reported by: (only one answer)
CL Item
Spouse (Spouse)
CL Item
Child (Child)
CL Item
Brother/Sister (Brother/Sister)
CL Item
Friend (Friend)
CL Item
Other attendant (Other attendant)
memory impairment informant
Item
1. Did the memory of the participant change for the worse?
boolean
C0233794 (UMLS CUI [1])
Item
Start of deterioation:
integer
C0233794 (UMLS CUI [1,1])
C0868945 (UMLS CUI [1,2])
C0332162 (UMLS CUI [1,3])
memory impairment onset
Code List
Start of deterioation:
CL Item
within the last six month (1)
CL Item
from six month ago on to two years ago (2)
CL Item
from two to five years ago (3)
CL Item
more than five years ago (4)
CL Item
not specified (5)
word finding informant
Item
2. Does the participant have frequently problems finding words?
boolean
C0454643 (UMLS CUI [1])
Item
Start of deterioation:
integer
C0454643 (UMLS CUI [1,1])
C0868945 (UMLS CUI [1,2])
C0332162 (UMLS CUI [1,3])
memory impairment onset
Code List
Start of deterioation:
CL Item
within the last six month (1)
CL Item
from six month ago on to two years ago (2)
CL Item
from two to five years ago (3)
CL Item
more than five years ago (4)
CL Item
not specified (5)
problems planning informant
Item
3. Does the participant have more often problems planning forward-thinking or keeping order?
boolean
C0423907 (UMLS CUI [1])
Item
Start of deterioation:
integer
C0423907 (UMLS CUI [1,1])
C0868945 (UMLS CUI [1,2])
C0332162 (UMLS CUI [1,3])
memory impairment onset
Code List
Start of deterioation:
CL Item
within the last six month (1)
CL Item
from six month ago on to two years ago (2)
CL Item
from two to five years ago (3)
CL Item
more than five years ago (4)
CL Item
not specified (5)
making mistakes informant
Item
4. Does the participant make mistakes more frequently, if he not fully concentrates on one thing?
boolean
C1821936 (UMLS CUI [1])
Item
Start of deterioation:
integer
C1821936 (UMLS CUI [1,1])
C0868945 (UMLS CUI [1,2])
C0332162 (UMLS CUI [1,3])
memory impairment onset
Code List
Start of deterioation:
CL Item
within the last six month (1)
CL Item
from six month ago on to two years ago (2)
CL Item
from two to five years ago (3)
CL Item
more than five years ago (4)
CL Item
not specified (5)
other mental deterioation informant
Item
5. Did you notice any other mental deterioration? In which sections?
boolean
C0234985 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
other mental deterioation name informant
Item
Other mental deterioation:
text
C0234985 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Item
Start of deterioation:
integer
C0234985 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0868945 (UMLS CUI [1,3])
C0332162 (UMLS CUI [1,4])
memory impairment onset
Code List
Start of deterioation:
CL Item
within the last six month (1)
CL Item
from six month ago on to two years ago (2)
CL Item
from two to five years ago (3)
CL Item
more than five years ago (4)
CL Item
not specified (5)
personality change
Item
6. Did you notice a change of behavior or personality of the participant?
boolean
C0240735 (UMLS CUI [1])
Item
Start of change:
integer
C0240735 (UMLS CUI [1,1])
C0868945 (UMLS CUI [1,2])
C0332162 (UMLS CUI [1,3])
memory impairment onset
Code List
Start of change:
CL Item
within the last six month (1)
CL Item
from six month ago on to two years ago (2)
CL Item
from two to five years ago (3)
CL Item
more than five years ago (4)
CL Item
not specified (5)
Item Group
Mini mental state examination (MMSE)
orientation in time
Item
1. Orientation 1.1. Orientation in time
integer
C0451306 (UMLS CUI [1])
C0599544 (UMLS CUI [2])
orientation to place
Item
1.2. Orientation to place
integer
C0451306 (UMLS CUI [1])
C2370999 (UMLS CUI [2])
retention in memory
Item
2. Retention in memory
integer
C0451306 (UMLS CUI [1])
C0598851 (UMLS CUI [2])
attention
Item
3. Attention
integer
C0451306 (UMLS CUI [1])
C0004268 (UMLS CUI [2])
memory
Item
4. Powers of recollection
integer
C0451306 (UMLS CUI [1])
C0025260 (UMLS CUI [2])
speech
Item
5. Speech
integer
C0451306 (UMLS CUI [1])
C0037817 (UMLS CUI [2])
drawing
Item
6. Drawing
integer
C0451306 (UMLS CUI [1])
C0013113 (UMLS CUI [2])
total score MMSE
Item
integer
C2225229 (UMLS CUI [1])
Item Group
Neuropsychologic testing
Item
1. Do you have difficulties hearing?
text
C1313969 (UMLS CUI [1])
difficulties hearing
Code List
1. Do you have difficulties hearing?
CL Item
No impairment (speech in normal sound level is understandable, no hearing device) (No impairment (speech in normal sound level is understandable, no hearing device))
CL Item
Mild impairment (only load speech can be understood, hearing aid device necessary) (Mild impairment (only load speech can be understood, hearing aid device necessary))
CL Item
Severe impairment (only if spoken out very loudly speech can be understood, communication very difficult) (Severe impairment (only if spoken out very loudly speech can be understood, communication very difficult))
CL Item
Extreme impairment/ loss of hearing (almost nothing/nothing can be understood) (Extreme impairment/ loss of hearing (almost nothing/nothing can be understood))
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