date of birth
Item
I would like to ask you a few questions that require concentration and memory. Some are a little bit more difficult than others. Some questions will be asked more than once. 1 When were you born?
date
C0421451 (UMLS CUI [1])
place of birth
Item
Where were you born? d. city/town
text
C0032040 (UMLS CUI [1])
Item
d. city/town
integer
C0032040 (UMLS CUI [1,1])
C1706817 (UMLS CUI [1,2])
CL Item
error/refused (1)
CL Item
not att/disabled (9)
place of birth state
Item
Where were you born? e. state/country
text
C1300001 (UMLS CUI [1])
Item
e. state/country
integer
C1300001 (UMLS CUI [1,1])
C1706817 (UMLS CUI [1,2])
Code List
e. state/country
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
2. I am going to say three words for you to remember. Repeat them after I have said all three words: shoes, brown, honestly. a. shoes
integer
C1705914 (UMLS CUI [1])
Code List
2. I am going to say three words for you to remember. Repeat them after I have said all three words: shoes, brown, honestly. a. shoes
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
b. brown
integer
C1705914 (UMLS CUI [1])
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
c. honestly
integer
C1705914 (UMLS CUI [1])
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
3 I would like you to count from 1 to 5. [...] Now I would like you to count backwards from 5 to 1.
text
C1882037 (UMLS CUI [1])
Code List
3 I would like you to count from 1 to 5. [...] Now I would like you to count backwards from 5 to 1.
CL Item
Able to count forward (Able to count forward)
CL Item
Unable to count forward (Unable to count forward)
counting number 5
Item
Record the responses in the order given: enter 99999 for no response
text
C1882037 (UMLS CUI [1])
counting number 4
Item
Record the responses in the order given: enter 99999 for no response
text
C1882037 (UMLS CUI [1])
counting number 3
Item
Record the responses in the order given: enter 99999 for no response
text
C1882037 (UMLS CUI [1])
counting number 2
Item
Record the responses in the order given: enter 99999 for no response
text
C1882037 (UMLS CUI [1])
counting number 1
Item
Record the responses in the order given: enter 99999 for no response
text
C1882037 (UMLS CUI [1])
Item
4 Spell "world". [...] Now spell "world" backwards.
text
C0869025 (UMLS CUI [1])
Code List
4 Spell "world". [...] Now spell "world" backwards.
CL Item
Able to spell (Able to spell)
CL Item
Unable to spell (Unable to spell)
spelling backwards
Item
Record letters in the order given (Enter xxxxx if no response) a. D
text
C0869025 (UMLS CUI [1])
spelling backwards 2
Item
b. L
text
C0869025 (UMLS CUI [1])
spelling backwards 3
Item
c. R
text
C0869025 (UMLS CUI [1])
spelling backwards 4
Item
d. O
text
C0869025 (UMLS CUI [1])
spelling backwards 5
Item
e. W
text
C0869025 (UMLS CUI [1])
Item
5 What three words did I ask you to remember earlier? a. shoes
text
C1705914 (UMLS CUI [1])
Code List
5 What three words did I ask you to remember earlier? a. shoes
CL Item
Spontaneous recall (Spontaneous recall)
CL Item
Correct word/incorrect form (Correct word/incorrect form)
CL Item
After "something to wear" (After "something to wear")
CL Item
After "Was it shirt, shoes or socks?" (After "Was it shirt, shoes or socks?")
CL Item
Unable to recall/refused (provide the correct answer) (Unable to recall/refused (provide the correct answer))
CL Item
Not attempted/disabled (Not attempted/disabled)
Item
5 What three words did I ask you to remember earlier? b. brown
text
C1705914 (UMLS CUI [1])
Code List
5 What three words did I ask you to remember earlier? b. brown
CL Item
Spontaneous recall (Spontaneous recall)
CL Item
Correct word/incorrect form (Correct word/incorrect form)
CL Item
After "A color" (After "A color")
CL Item
After "Was it blue, black, brown?" (After "Was it blue, black, brown?")
CL Item
Unable to recall/refused (provide correct answer) (Unable to recall/refused (provide correct answer))
CL Item
Not attempted/disabled (Not attempted/disabled)
Item
5 What three words did I ask you to remember earlier? c. honestly
text
C1705914 (UMLS CUI [1])
Code List
5 What three words did I ask you to remember earlier? c. honestly
CL Item
Spontaneous recall (Spontaneous recall)
CL Item
Correct word/incorrect form (Correct word/incorrect form)
CL Item
After "A good personal quality" (After "A good personal quality")
CL Item
After "Was it honestly, charity, modesty?" (After "Was it honestly, charity, modesty?")
CL Item
Unable to recall/refused (provide the correct answer) (Unable to recall/refused (provide the correct answer))
CL Item
Not attempted/disabled (Not attempted/disabled)
cognitive q1 date
Item
6a. a. What is today's date?
date
C0563117 (UMLS CUI [1])
q1 answer in error
Item
Record answer in error:
text
Item
b. What is the day of the week?
integer
C0585023 (UMLS CUI [1])
Code List
b. What is the day of the week?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
q2 answer in error
Item
Day:
text
Item
c. What season of the year is it?
integer
C0036497 (UMLS CUI [1])
Code List
c. What season of the year is it?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
q3 answer in error
Item
Season:
text
Item
7a. What state are we in?
integer
C1301808 (UMLS CUI [1])
Code List
7a. What state are we in?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
q7a answer in error
Item
State:
text
Item
b. What country are you in?
integer
C0454664 (UMLS CUI [1])
Code List
b. What country are you in?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
q7b answer in error
Item
Country:
text
Item
c. What (city/town) are we in?
integer
C0008848 (UMLS CUI [1])
Code List
c. What (city/town) are we in?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
q7c answer in error
Item
City:
text
Item
d. Are we in a clinic, store, or at home?
integer
C0442504 (UMLS CUI [1])
Code List
d. Are we in a clinic, store, or at home?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
8 Point to the object or a part of your own body and ask the participant to name it. Score 0 if the participant cannot name it within 2 seconds or gives an incorrect name. Do not wait for the participant to mentally search for the name. a. pencil: What is this?
integer
C0451342 (UMLS CUI [1])
Code List
8 Point to the object or a part of your own body and ask the participant to name it. Score 0 if the participant cannot name it within 2 seconds or gives an incorrect name. Do not wait for the participant to mentally search for the name. a. pencil: What is this?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
b. watch: What is this?
integer
C0451342 (UMLS CUI [1])
Code List
b. watch: What is this?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
c. forehead: What do you call this part of the face?
integer
C0451342 (UMLS CUI [1])
Code List
c. forehead: What do you call this part of the face?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
d. chin: ...And this part?
integer
C0451342 (UMLS CUI [1])
Code List
d. chin: ...And this part?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
e. shoulder: ...And this part of the body?
integer
C0451342 (UMLS CUI [1])
Code List
e. shoulder: ...And this part of the body?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
f. elbow: ... And this part?
integer
C0451342 (UMLS CUI [1])
Code List
f. elbow: ... And this part?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
g. knuckie: ... And this part of the hand?
integer
C0451342 (UMLS CUI [1])
Code List
g. knuckie: ... And this part of the hand?
CL Item
error/refused (1)
CL Item
not att/disabled (9)
enumerate animals score
Item
Score
integer
C0449820 (UMLS CUI [1])
Item
10a. In what way are an arm and a leg alike?
text
C1273102 (UMLS CUI [1])
Code List
10a. In what way are an arm and a leg alike?
CL Item
Limbs, extremeties (Limbs, extremeties)
CL Item
Lesser correct answer (e.g. body parts, both bend, have joints) (Lesser correct answer (e.g. body parts, both bend, have joints))
CL Item
Error (e.g. states differences, gives unrelated answer)/refuses (Error (e.g. states differences, gives unrelated answer)/refuses)
CL Item
Not attempted/disabled (Not attempted/disabled)
Item
10b. In what way are laughing and crying alike?
text
C1273102 (UMLS CUI [1])
Code List
10b. In what way are laughing and crying alike?
CL Item
Expression of feelings, emotions (Expression of feelings, emotions)
CL Item
Lesser correct answer (e.g. sounds, expressions) (Lesser correct answer (e.g. sounds, expressions))
CL Item
Error (e.g. states differences, gives unrelated answer)/refuses (Error (e.g. states differences, gives unrelated answer)/refuses)
CL Item
Not attempted/disabled (Not attempted/disabled)
Item
10c. In what way are eating and sleeping alike?
text
C1273102 (UMLS CUI [1])
Code List
10c. In what way are eating and sleeping alike?
CL Item
Necessary body functions, essential for life (Necessary body functions, essential for life)
CL Item
Lesser correct answer (Lesser correct answer )
CL Item
Error (e.g. states differences, gives unrelated answer)/refuses (Error (e.g. states differences, gives unrelated answer)/refuses)
CL Item
Not attempted/disabled (Not attempted/disabled)
Item
12 Now repeat: No ifs, ands or buts. a. no ifs
integer
C3828340 (UMLS CUI [1])
Code List
12 Now repeat: No ifs, ands or buts. a. no ifs
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
12 Now repeat: No ifs, ands or buts. b. ands
integer
C3828340 (UMLS CUI [1])
Code List
12 Now repeat: No ifs, ands or buts. b. ands
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
12 Now repeat: No ifs, ands or buts. c. or buts
integer
C3828340 (UMLS CUI [1])
Code List
12 Now repeat: No ifs, ands or buts. c. or buts
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
13 Please do this:
text
C1273101 (UMLS CUI [1,1])
C1442085 (UMLS CUI [1,2])
Code List
13 Please do this:
CL Item
Closes eyes without prompting (Closes eyes without prompting)
CL Item
Closes eyes after prompting (Closes eyes after prompting)
CL Item
Reads aloud, but does not close eyes (Reads aloud, but does not close eyes)
CL Item
Does not read aloud or close eyes/refused (Does not read aloud or close eyes/refused)
CL Item
Not attempted/disabled (Not attempted/disabled)
Item
14 I would like to have a sample of your handwritting. Please write: I would like to go out. a. would
integer
C0018582 (UMLS CUI [1])
Code List
14 I would like to have a sample of your handwritting. Please write: I would like to go out. a. would
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
14 I would like to have a sample of your handwritting. Please write: I would like to go out. b. like
integer
C0018582 (UMLS CUI [1])
Code List
14 I would like to have a sample of your handwritting. Please write: I would like to go out. b. like
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
14 I would like to have a sample of your handwritting. Please write: I would like to go out. c. to
integer
C0018582 (UMLS CUI [1])
Code List
14 I would like to have a sample of your handwritting. Please write: I would like to go out. c. to
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
14 I would like to have a sample of your handwritting. Please write: I would like to go out. d. go
integer
C0018582 (UMLS CUI [1])
Code List
14 I would like to have a sample of your handwritting. Please write: I would like to go out. d. go
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
14 I would like to have a sample of your handwritting. Please write: I would like to go out. e. out
integer
C0018582 (UMLS CUI [1])
Code List
14 I would like to have a sample of your handwritting. Please write: I would like to go out. e. out
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
Note which hand the participant uses to write. If this task is not done, ask participant if s/he is right or left-handed.
text
C0023114 (UMLS CUI [1])
Code List
Note which hand the participant uses to write. If this task is not done, ask participant if s/he is right or left-handed.
CL Item
Unknown (Unknown)
Item
15 Here is a drawing. Please copy the drawing onto this paper. a. pentagon 1
text
C0699866 (UMLS CUI [1,1])
C1709496 (UMLS CUI [1,2])
Code List
15 Here is a drawing. Please copy the drawing onto this paper. a. pentagon 1
CL Item
5 approximately equal sized (5 approximately equal sized)
CL Item
5 slides, but longest:shortest >2:1 (5 slides, but longest:shortest >2:1)
CL Item
Nonpentagon enclosed figure (Nonpentagon enclosed figure)
CL Item
2 or more lines, not an enclosure (2 or more lines, not an enclosure)
CL Item
Less than 2 lines/refused (Less than 2 lines/refused)
CL Item
Not attempted/disabled (Not attempted/disabled)
Item
15 Here is a drawing. Please copy the drawing onto this paper. b. pentagon 2
text
C0699866 (UMLS CUI [1,1])
C1709496 (UMLS CUI [1,2])
Code List
15 Here is a drawing. Please copy the drawing onto this paper. b. pentagon 2
CL Item
5 approximately equal sized (5 approximately equal sized)
CL Item
5 slides, but longest:shortest >2:1 (5 slides, but longest:shortest >2:1)
CL Item
Nonpentagon enclosed figure (Nonpentagon enclosed figure)
CL Item
2 or more lines, not an enclosure (2 or more lines, not an enclosure)
CL Item
Less than 2 lines/refused (Less than 2 lines/refused)
CL Item
Not attempted/disabled (Not attempted/disabled)
drawing task 3
Item
15 Here is a drawing. Please copy the drawing onto this paper. c. intersection
text
C0699866 (UMLS CUI [1,1])
C1709496 (UMLS CUI [1,2])
Item
16 Take this paper with your left (right for left-handed person) hand, fold it in half, and hand it back to me. a. takes paper in correct hand
integer
C0392334 (UMLS CUI [1])
Code List
16 Take this paper with your left (right for left-handed person) hand, fold it in half, and hand it back to me. a. takes paper in correct hand
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
16 Take this paper with your left (right for left-handed person) hand, fold it in half, and hand it back to me. c. hands paper back
integer
Code List
16 Take this paper with your left (right for left-handed person) hand, fold it in half, and hand it back to me. c. hands paper back
CL Item
error/refused (1)
CL Item
not att/disabled (9)
Item
17 What three words did I ask you to remember earlier? a. shoes
text
C1705914 (UMLS CUI [1])
Code List
17 What three words did I ask you to remember earlier? a. shoes
CL Item
Spontaneous recall (Spontaneous recall)
CL Item
Correct word/incorrect form (Correct word/incorrect form)
CL Item
After "something to wear" (After "something to wear")
CL Item
After "Was it shirt, shoes or socks?" (After "Was it shirt, shoes or socks?")
CL Item
Unable to recall/refused (provide the correct answer) (Unable to recall/refused (provide the correct answer))
CL Item
Not attempted/disabled (Not attempted/disabled)
Item
17 What three words did I ask you to remember earlier? b. brown
text
C1705914 (UMLS CUI [1])
Code List
17 What three words did I ask you to remember earlier? b. brown
CL Item
Spontaneous recall (Spontaneous recall)
CL Item
Correct word/incorrect form (Correct word/incorrect form)
CL Item
After "A color" (After "A color")
CL Item
After "Was it blue, black, brown?" (After "Was it blue, black, brown?")
CL Item
Unable to recall/refused (provide correct answer) (Unable to recall/refused (provide correct answer))
CL Item
Not attempted/disabled (Not attempted/disabled)
Item
17 What three words did I ask you to remember earlier? c. honestly
text
C1705914 (UMLS CUI [1])
Code List
17 What three words did I ask you to remember earlier? c. honestly
CL Item
Spontaneous recall (Spontaneous recall)
CL Item
Correct word/incorrect form (Correct word/incorrect form)
CL Item
After "A good personal quality" (After "A good personal quality")
CL Item
After "Was it honestly, charity, modesty?" (After "Was it honestly, charity, modesty?")
CL Item
Unable to recall/refused (provide the correct answer) (Unable to recall/refused (provide the correct answer))
CL Item
Not attempted/disabled (Not attempted/disabled)
place of birth
Item
18 Would you please tell me again where you were born? a. city/town
text
C0032040 (UMLS CUI [1])
Item
d. city/town
integer
C0032040 (UMLS CUI [1,1])
C1706817 (UMLS CUI [1,2])
CL Item
error/refused (1)
CL Item
not att/disabled (9)
place of birth state 2
Item
b. state/country
text
C1300001 (UMLS CUI [1])
Item
b. state/country
integer
C1300001 (UMLS CUI [1,1])
C1706817 (UMLS CUI [1,2])
Code List
b. state/country
CL Item
error/refused (1)
CL Item
not att/disabled (9)
special problems
Item
19 Special problems?
boolean
C1254481 (UMLS CUI [1])
Item
Primary problem:
text
C3258059 (UMLS CUI [1])
Code List
Primary problem:
CL Item
Hearing (Hearing)
CL Item
Inability to write due to injury/illness (Inability to write due to injury/illness)
CL Item
Illiteracy/lack of education (Illiteracy/lack of education)
CL Item
Language (difficulty speaking/understanding English) (Language (difficulty speaking/understanding English))
other primary problem
Item
Other, specify:
text
C3258059 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
secondary problem
Item
Secondary problem, specify:
text
C3258145 (UMLS CUI [1])
Item
20 Please tell me which hand you would normally use to throw a ball to hit a target.
text
C2734046 (UMLS CUI [1])
Code List
20 Please tell me which hand you would normally use to throw a ball to hit a target.
CL Item
Always left (Always left)
CL Item
Usually left (Usually left)
CL Item
No preference (No preference)
CL Item
Usually right (Usually right)
CL Item
Always right (Always right)
CL Item
Unknown (Unknown)
Item
21 Please tell me which hand you would normally use to hold a toothbrush while cleaning teeth.
text
C2734038 (UMLS CUI [1])
Code List
21 Please tell me which hand you would normally use to hold a toothbrush while cleaning teeth.
CL Item
Always left (Always left)
CL Item
Usually left (Usually left)
CL Item
No preference (No preference)
CL Item
Usually right (Usually right)
CL Item
Always right (Always right)
CL Item
Unknown (Unknown)
Item
22 Look at these boxes across the top of the page. On the top of each box are numbers from one through nine. On the bottom part of each box there is a symbol. Each symbol is paired with a number. -- Down here are boxes with numbers on the top, but the bottom part is blank. I want you to put the correct symbol in each box like this: -- Now I want you to fill in all boxes up to this line. -- When I tell you to begin, start here and fill in the boxes in these four rows. Do them in any order and don't skip any. Please try to work as quickly as possible. Let's begin. -- That's good. That completes this set of tasks. a. Test items:
integer
C0814254 (UMLS CUI [1])
Code List
22 Look at these boxes across the top of the page. On the top of each box are numbers from one through nine. On the bottom part of each box there is a symbol. Each symbol is paired with a number. -- Down here are boxes with numbers on the top, but the bottom part is blank. I want you to put the correct symbol in each box like this: -- Now I want you to fill in all boxes up to this line. -- When I tell you to begin, start here and fill in the boxes in these four rows. Do them in any order and don't skip any. Please try to work as quickly as possible. Let's begin. -- That's good. That completes this set of tasks. a. Test items:
CL Item
Not done/refused (0)
CL Item
Not attempted/disabled (9)
digit-symbol substitution task 2
Item
b. Number of symbols correctly coded:
integer
C0814254 (UMLS CUI [1])
digit-symbol substitution task 3
Item
c. Number of symbols incorrectly coded:
integer
C0814254 (UMLS CUI [1])
name animals
Item
9 What animals have four legs? Tell me as many as you can.
text
C1707927 (UMLS CUI [1,1])
C0003062 (UMLS CUI [1,2])
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