ID

28019

Beskrivning

Double blind, randomised, prospective placebo controlled parallel group phase III study to investigate the effect of EGCG supplementation on disease progression of patients with Multiple System Atrophy (MSA) NCT02008721 Short title: Progression Rate of MSA under EGCG Supplementation as anti-Aggregation-Approach Study Code: PROMESA EudraCT-Number: 2012-000928-18 NCT02008721 Sponsor: Klinikum Großhadern Medical Center University of Munich,Represented by the Medical Director Prof. Dr. med. Burkhard Göke, Marchioninistraße 15 D-81377 Munich Principal Investigator: Prof. Dr. med. Günter Höglinger Department of Neurology, Klinikum rechts der Isar Technische Universität München Ismaninger Str. 22 D-81675 Munich; Contact: Yvonne Rödenbeck Trial Monitoring: Münchner Studienzentrum Klinikum rechts der Isar ,Technische Universität München, Ismaninger Str.22 D-81675 Munich Trial Monitoring: Prof. Dr. rer. nat. Ulrich Masnmann, Institute for Medical Informatics, Biometry and Epidemiology (IBE), Marchioninistraße 15 D-81377 Munich Trial Office: Deutsches Zentrum für Neurodegenerative Erkrankungen e.V., Max-Lebsche Platz 30, D-81377 Munich Source: Priv.-Doz. Dr. med. Johannes Levin Neurologische Klinik Ludwig-Maximilians-Universität München

Nyckelord

  1. 2017-12-10 2017-12-10 -
Rättsinnehavare

Priv.-Doz. Dr. med. Johannes Levin

Uppladdad den

10 december 2017

DOI

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Licens

Creative Commons BY-NC 3.0

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PROMESA NCT02008721

Baseline Visit (V1)

  1. StudyEvent: ODM
    1. Baseline Visit (V1)
Date of Visit
Beskrivning

Date of Visit

Alias
UMLS CUI-1
C2097637
Date of visit
Beskrivning

Date of visit

Datatyp

date

Alias
UMLS CUI [1]
C1320303
Screening visit performed at same date of baseline visit?
Beskrivning

Date of visit

Datatyp

boolean

Alias
UMLS CUI [1]
C1320303
Randomisation/Inclusion of the patient
Beskrivning

Randomisation/Inclusion of the patient

Alias
UMLS CUI-1
C0034656
Randomisation/Inclusion of the patient
Beskrivning

Randomisation

Datatyp

integer

Alias
UMLS CUI [1]
C0034656
Date of randomisation
Beskrivning

Date of randomisation

Datatyp

date

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0011008
Randomisation Number
Beskrivning

Randomisation Number

Datatyp

integer

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0237753
Recent Medical history
Beskrivning

Recent Medical history

Alias
UMLS CUI-1
C0262926
Changes in relevant medical history since screening visit
Beskrivning

relevant medical history

Datatyp

integer

Alias
UMLS CUI [1]
C0262926
Recent Medical History
Beskrivning

Recent Medical History

Alias
UMLS CUI-1
C0262926
Body system
Beskrivning

Body system

Datatyp

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0460002
Disease/Diagnosis
Beskrivning

Diagnosis

Datatyp

text

Alias
UMLS CUI [1]
C0011900
Start of disease or surgery
Beskrivning

Start of disease or surgery

Datatyp

date

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0808070
UMLS CUI [2]
C1628561
Not known
Beskrivning

Start Date not known

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0808070
UMLS CUI [1,2]
C0439673
End of disease or surgery
Beskrivning

End of disease or surgery

Datatyp

date

Alias
UMLS CUI [1]
C4019088
UMLS CUI [2,1]
C0543467
UMLS CUI [2,2]
C0444930
Not known
Beskrivning

End date unknown

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0806020
UMLS CUI [1,2]
C0439673
Persistent
Beskrivning

Disease persistent

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0205322
MSA History
Beskrivning

MSA History

Alias
UMLS CUI-1
C0393571
UMLS CUI-2
C0262926
Changes in MSA History since Screening visit (V0)
Beskrivning

Changes in MSA History since Screening visit (V0)

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0393571
UMLS CUI [1,2]
C1457887
Syncope
Beskrivning

MSA syncope

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0393571
UMLS CUI [1,2]
C0039070
Orthostatic hypotension
Beskrivning

MSA Orthostatic hypotension

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0393571
UMLS CUI [1,2]
C0020651
Urinary Incontinence
Beskrivning

MSA Urinary Incontinence

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0393571
UMLS CUI [1,2]
C0042024
Erectile Dysfuntion
Beskrivning

MSA Erectile Dysfuntion

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0393571
UMLS CUI [1,2]
C2733447
Other (please specify)
Beskrivning

MSA Other autonomic symptoms

Datatyp

text

Alias
UMLS CUI [1,1]
C0393571
UMLS CUI [1,2]
C2674101
UMLS CUI [1,3]
C1521902
Bradykinesia
Beskrivning

MSA Bradykinesia

Datatyp

boolean

Alias
UMLS CUI [1,1]
C2733447
UMLS CUI [1,2]
C3176307
Rigidity
Beskrivning

MSA Rigidity

Datatyp

boolean

Alias
UMLS CUI [1,1]
C2733447
UMLS CUI [1,2]
C0858572
Tremor
Beskrivning

MSA Tremor

Datatyp

boolean

Alias
UMLS CUI [1,1]
C2733447
UMLS CUI [1,2]
C0040822
Resting tremor
Beskrivning

Only answer, if answer to previous question was 'yes'.

Datatyp

boolean

Alias
UMLS CUI [1]
C0234379
Postural tremor
Beskrivning

Only answer, if answer to previous question was 'yes'.

Datatyp

boolean

Alias
UMLS CUI [1]
C0234378
other (please specify)
Beskrivning

MSA Other parkinsonism symptoms

Datatyp

text

Alias
UMLS CUI [1,1]
C2733447
UMLS CUI [1,2]
C1457887
UMLS CUI [1,3]
C1521902
Gait ataxia
Beskrivning

MSA Gait ataxia

Datatyp

boolean

Alias
UMLS CUI [1,1]
C2732311
UMLS CUI [1,2]
C0751837
Limb ataxia
Beskrivning

MSA limb ataxia

Datatyp

boolean

Alias
UMLS CUI [1,1]
C2732311
UMLS CUI [1,2]
C4015302
Other (please specify)
Beskrivning

MSA Other cerebellar symptoms

Datatyp

text

Alias
UMLS CUI [1,1]
C2732311
UMLS CUI [1,2]
C0037088
UMLS CUI [1,3]
C1521902
Current frequency of falls
Beskrivning

since last visit

Datatyp

integer

Alias
UMLS CUI [1]
C1285588
Psychiatric history
Beskrivning

Psychiatric history

Alias
UMLS CUI-1
C0748059
Psychiatric history
Beskrivning

Psychiatric history

Datatyp

boolean

Alias
UMLS CUI [1]
C0748059
Delusions
Beskrivning

delusion

Datatyp

boolean

Alias
UMLS CUI [1]
C0011253
If yes, please specify
Beskrivning

Delsuions specify

Datatyp

text

Alias
UMLS CUI [1,1]
C0011253
UMLS CUI [1,2]
C1521902
Hallucinations
Beskrivning

Hallucinations

Datatyp

boolean

Alias
UMLS CUI [1]
C0018524
If yes, please specify.
Beskrivning

Hallucinations specify

Datatyp

text

Alias
UMLS CUI [1,1]
C0018524
UMLS CUI [1,2]
C1521902
Affective disorder
Beskrivning

Affective disorder

Datatyp

boolean

Alias
UMLS CUI [1]
C0525045
If yes, please specify.
Beskrivning

Affective disorder specify

Datatyp

text

Alias
UMLS CUI [1,1]
C0525045
UMLS CUI [1,2]
C1521902
Other
Beskrivning

psychiatric history other

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0748059
UMLS CUI [1,2]
C0205394
If yes, please specify.
Beskrivning

Other psychiatric history specify

Datatyp

text

Alias
UMLS CUI [1,1]
C0748059
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C1521902
Concomitant medication
Beskrivning

Concomitant medication

Alias
UMLS CUI-1
C2347852
Does the patient take any concomitant medication?
Beskrivning

If Yes, please fill in Concomitant Medication Record.

Datatyp

boolean

Alias
UMLS CUI [1]
C2347852
Has the patient a stable regimen for at least one month for drugs acting against Parkinsonism.
Beskrivning

If no, exclusion of the patient.

Datatyp

boolean

Alias
UMLS CUI [1]
C0003405
Has the patient a stable regimen for at least one month for drugs acting against autonomic dysfunction.
Beskrivning

If no, exclusion of the patient.

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C3277919
Has the patient a stable regimen for at least one month for antidepressant and antidementive drugs.
Beskrivning

If no, exclusion of the patient.

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0003289
UMLS CUI [1,3]
C0497327
Vital signs
Beskrivning

Vital signs

Alias
UMLS CUI-1
C0031809
Systolic Blood Pressure
Beskrivning

Systolic Blood Pressure

Datatyp

integer

Måttenheter
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Diastolic blood pressure
Beskrivning

Diastolic blood pressure

Datatyp

integer

Måttenheter
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Heart rate
Beskrivning

Heart rate

Datatyp

integer

Måttenheter
  • bpm
Alias
UMLS CUI [1]
C0018810
bpm
Temperature
Beskrivning

Body Temperature

Datatyp

integer

Måttenheter
  • °C
Alias
UMLS CUI [1]
C0005903
°C
Physical examination
Beskrivning

Physical examination

Alias
UMLS CUI-1
C0031809
General physical examination
Beskrivning

General physical examination

Datatyp

integer

Alias
UMLS CUI [1]
C0031809
Physical examination
Beskrivning

Physical examination

Alias
UMLS CUI-1
C0031809
Code
Beskrivning

pHysical examination code

Datatyp

integer

Alias
UMLS CUI [1,1]
C0031809
UMLS CUI [1,2]
C0805701
Finding
Beskrivning

physical examination finding

Datatyp

text

Alias
UMLS CUI [1,1]
C0031809
UMLS CUI [1,2]
C0243095
Neurological examination
Beskrivning

Neurological examination

Alias
UMLS CUI-1
C0027853
Cranial nerves
Beskrivning

Neurologic examination cranial nerves

Datatyp

integer

Alias
UMLS CUI [1,1]
C0027853
UMLS CUI [1,2]
C0558819
If abnormal, specify
Beskrivning

cranial nerves examination specify

Datatyp

text

Alias
UMLS CUI [1,1]
C0027853
UMLS CUI [1,2]
C0558819
UMLS CUI [1,3]
C1521902
Motor function
Beskrivning

Neurologic examination Motor function

Datatyp

integer

Alias
UMLS CUI [1,1]
C0027853
UMLS CUI [1,2]
C0234130
If abnormal, specify
Beskrivning

Motor function specify

Datatyp

text

Alias
UMLS CUI [1,1]
C0027853
UMLS CUI [1,2]
C0234130
UMLS CUI [1,3]
C1521902
Reflexes
Beskrivning

Neurologic examination Reflexes

Datatyp

integer

Alias
UMLS CUI [1,1]
C0027853
UMLS CUI [1,2]
C0436145
If abnormal, specify
Beskrivning

Reflexes specify

Datatyp

text

Alias
UMLS CUI [1,1]
C0027853
UMLS CUI [1,2]
C0436145
UMLS CUI [1,3]
C1521902
Coordination
Beskrivning

Neurologic examination coordination

Datatyp

integer

Alias
UMLS CUI [1,1]
C0027853
UMLS CUI [1,2]
C0242414
If abnormal, specify
Beskrivning

Coordination specify

Datatyp

text

Alias
UMLS CUI [1,1]
C0027853
UMLS CUI [1,2]
C0242414
UMLS CUI [1,3]
C1521902
Sensation
Beskrivning

Neurologic examination sensation

Datatyp

integer

Alias
UMLS CUI [1,1]
C0027853
UMLS CUI [1,2]
C0036658
If abnormal, specify
Beskrivning

Sensation specify

Datatyp

text

Alias
UMLS CUI [1,1]
C0027853
UMLS CUI [1,2]
C0036658
UMLS CUI [1,3]
C1521902
Pregnancy test
Beskrivning

Pregnancy test

Alias
UMLS CUI-1
C0032976
Pregnancy test
Beskrivning

Pregnancy test

Datatyp

integer

Alias
UMLS CUI [1]
C0032976
Laboratory test
Beskrivning

Laboratory test

Alias
UMLS CUI-1
C0022885
Date
Beskrivning

d laboratory! Please fill in the raised values and assess whether they´re normal or not. If abnormal, evaluate if it is clinically significant or not. If the value is abnormal and clinically significant, please document as concomitant disease under medical history.

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0022885
Laboratory test
Beskrivning

Laboratory test

Alias
UMLS CUI-1
C0022885
Type of laboratory procedure
Beskrivning

Type of laboratory procedure

Datatyp

integer

Alias
UMLS CUI [1]
C0022885
Value
Beskrivning

Laboratory procedure value

Datatyp

float

Alias
UMLS CUI [1,1]
C0587081
UMLS CUI [1,2]
C0587081
Normal
Beskrivning

Laboratory result normal

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0587081
UMLS CUI [1,2]
C0459422
Clinical significant
Beskrivning

Laboratory finding significant

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0456984
UMLS CUI [1,2]
C0750502
Clinically not significant
Beskrivning

Laboratory finding not significant

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0587081
UMLS CUI [1,2]
C2985739
Not done
Beskrivning

Laboratory test not done

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0022885
UMLS CUI [1,2]
C0445106
Unified MSA Rating scale - Part 1: Historical review
Beskrivning

Unified MSA Rating scale - Part 1: Historical review

Alias
UMLS CUI-1
C0393571
UMLS CUI-2
C0681889
Speech
Beskrivning

Speech UMSARS

Datatyp

integer

Alias
UMLS CUI [1]
C0037817
Swallowing
Beskrivning

Swallowing UMSARS

Datatyp

integer

Alias
UMLS CUI [1]
C0392678
Handwritting
Beskrivning

Handwritting

Datatyp

integer

Alias
UMLS CUI [1]
C0018582
Cutting food and handling utensils
Beskrivning

Cutting food and handling utensils

Datatyp

integer

Alias
UMLS CUI [1]
C3639844
Dressing
Beskrivning

Dressing

Datatyp

integer

Alias
UMLS CUI [1]
C3639845
Hygiene
Beskrivning

Hygiene

Datatyp

integer

Alias
UMLS CUI [1]
C3639846
Walking
Beskrivning

Walking

Datatyp

integer

Alias
UMLS CUI [1]
C0080331
Falling
Beskrivning

Falling

Datatyp

text

Alias
UMLS CUI [1]
C3639848
Orthostatic symptoms
Beskrivning

Orthostatic symptoms

Datatyp

integer

Alias
UMLS CUI [1]
C3203485
Urinary function
Beskrivning

Urinary function

Datatyp

integer

Alias
UMLS CUI [1]
C0871563
Sexual function
Beskrivning

Sexual function

Datatyp

integer

Alias
UMLS CUI [1]
C0260667
Bowel function
Beskrivning

Bowel function

Datatyp

integer

Alias
UMLS CUI [1]
C1290944
Unified MSA rating scale - Part 2: Motor examination scale
Beskrivning

Unified MSA rating scale - Part 2: Motor examination scale

Alias
UMLS CUI-1
C0393571
UMLS CUI-2
C0681889
Facial expression
Beskrivning

Facial expression

Datatyp

integer

Alias
UMLS CUI [1]
C0015457
Speech
Beskrivning

Speech

Datatyp

integer

Alias
UMLS CUI [1]
C0037817
Ocular motor dysfunction
Beskrivning

Ocular motor dysfunction

Datatyp

integer

Alias
UMLS CUI [1]
C0234130
Tremor at rest
Beskrivning

Tremor at rest

Datatyp

integer

Alias
UMLS CUI [1]
C0234379
Action tremor
Beskrivning

Action tremor

Datatyp

integer

Alias
UMLS CUI [1]
C0234376
Increased tone
Beskrivning

Increased muscle tone

Datatyp

integer

Alias
UMLS CUI [1]
C0026841
Rapid alternating movements of hands
Beskrivning

Rapid alternating movements of hands

Datatyp

integer

Alias
UMLS CUI [1,1]
C3166247
UMLS CUI [1,2]
C3166248
Finger taps
Beskrivning

Finger taps

Datatyp

integer

Alias
UMLS CUI [1,1]
C3827716
UMLS CUI [1,2]
C3827717
Leg agility
Beskrivning

Leg agility

Datatyp

integer

Alias
UMLS CUI [1,1]
C3827710
UMLS CUI [1,2]
C3827711
Heel-knee-skin test
Beskrivning

Heel-knee-skin test

Datatyp

integer

Alias
UMLS CUI [1]
C0278160
Arising from chair
Beskrivning

arising from chair

Datatyp

integer

Alias
UMLS CUI [1,1]
C1290946
UMLS CUI [1,2]
C3639721
Posture
Beskrivning

posture

Datatyp

integer

Alias
UMLS CUI [1]
C0426976
Body sway
Beskrivning

Body sway

Datatyp

integer

Alias
UMLS CUI [1]
C0870214
Gait
Beskrivning

Gait

Datatyp

integer

Alias
UMLS CUI [1]
C0016928
Unified MSA rating scale - Part 3: Autonomic examination
Beskrivning

Unified MSA rating scale - Part 3: Autonomic examination

Alias
UMLS CUI-1
C0393571
UMLS CUI-2
C0681889
Body position
Beskrivning

Body position

Datatyp

integer

Alias
UMLS CUI [1]
C1262869
Systolic Blood Pressure
Beskrivning

Systolic Blood Pressure

Datatyp

integer

Måttenheter
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Diastolic blood pressure
Beskrivning

Diastolic blood pressure

Datatyp

integer

Måttenheter
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Heart rate
Beskrivning

Heart rate

Datatyp

integer

Måttenheter
  • bpm
Alias
UMLS CUI [1]
C0018810
bpm
Unable to record
Beskrivning

vital signs Unable to record

Datatyp

boolean

Alias
UMLS CUI [1]
C0518766
Unified MSA rating scale - Part 4: Global disability scale
Beskrivning

Unified MSA rating scale - Part 4: Global disability scale

Alias
UMLS CUI-1
C0393571
UMLS CUI-2
C0681889
Global disability scale
Beskrivning

Global disability scale

Datatyp

integer

Alias
UMLS CUI [1]
C0451125
Clinical Global Impression (CGI)
Beskrivning

Clinical Global Impression (CGI)

Alias
UMLS CUI-1
C3639708
Severity of illness
Beskrivning

Severity of illness

Datatyp

integer

Alias
UMLS CUI [1]
C3639887
MRI at Baseline
Beskrivning

MRI at Baseline

Alias
UMLS CUI-1
C0024485
MRI at Baseline
Beskrivning

MRI at Baseline

Datatyp

text

Alias
UMLS CUI [1,1]
C0024485
UMLS CUI [1,2]
C1442488
Date of MRI
Beskrivning

Date of MRI

Datatyp

date

Alias
UMLS CUI [1,1]
C0024485
UMLS CUI [1,2]
C0011008
Study medication
Beskrivning

Study medication

Alias
UMLS CUI-1
C0013227
UMLS CUI-2
C0304229
Trial medication distribution
Beskrivning

Trial medication distribution

Datatyp

integer

Alias
UMLS CUI [1,1]
C3854006
UMLS CUI [1,2]
C3469597
Date
Beskrivning

Date of study drug distribution

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0304229
UMLS CUI [1,3]
C1512806
Number of Capsules dispensed
Beskrivning

Capsules (EGCG 400mg or Placebo) Regimen 1-0-0 Total dose 400mg/d

Datatyp

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0805077
Planned medication start
Beskrivning

Planned medication start

Datatyp

date

Alias
UMLS CUI [1,1]
C1521826
UMLS CUI [1,2]
C0808070
Signature of investigator
Beskrivning

Signature of investigator

Alias
UMLS CUI-1
C2346576
Date of Investigator Signature
Beskrivning

Investigator Signature Date

Datatyp

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
Name of investigator
Beskrivning

Investigator name

Datatyp

text

Alias
UMLS CUI [1]
C2826892
Investigator signature
Beskrivning

I confirm the correctness of the data documented above.

Datatyp

text

Alias
UMLS CUI [1]
C2346576

Similar models

Baseline Visit (V1)

  1. StudyEvent: ODM
    1. Baseline Visit (V1)
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Date of Visit
C2097637 (UMLS CUI-1)
Date of visit
Item
Date of visit
date
C1320303 (UMLS CUI [1])
Date of visit
Item
Screening visit performed at same date of baseline visit?
boolean
C1320303 (UMLS CUI [1])
Item Group
Randomisation/Inclusion of the patient
C0034656 (UMLS CUI-1)
Item
Randomisation/Inclusion of the patient
integer
C0034656 (UMLS CUI [1])
Code List
Randomisation/Inclusion of the patient
CL Item
done (1)
CL Item
not done (2)
Date of randomisation
Item
Date of randomisation
date
C0034656 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Randomisation Number
Item
Randomisation Number
integer
C0034656 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Item Group
Recent Medical history
C0262926 (UMLS CUI-1)
Item
Changes in relevant medical history since screening visit
integer
C0262926 (UMLS CUI [1])
Code List
Changes in relevant medical history since screening visit
CL Item
Yes (please specify below) (1)
CL Item
No (2)
Item Group
Recent Medical History
C0262926 (UMLS CUI-1)
Item
Body system
integer
C0262926 (UMLS CUI [1,1])
C0460002 (UMLS CUI [1,2])
Code List
Body system
CL Item
Cardiovascular (01)
CL Item
Pulmonary (02)
CL Item
Abdominal (03)
CL Item
Genitourinary (04)
CL Item
Skeletal/Muscular (05)
CL Item
Surgery/Hospital Admission (06)
CL Item
Other (07)
Diagnosis
Item
Disease/Diagnosis
text
C0011900 (UMLS CUI [1])
Start of disease or surgery
Item
Start of disease or surgery
date
C0012634 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
C1628561 (UMLS CUI [2])
Start Date not known
Item
Not known
boolean
C0808070 (UMLS CUI [1,1])
C0439673 (UMLS CUI [1,2])
End of disease or surgery
Item
End of disease or surgery
date
C4019088 (UMLS CUI [1])
C0543467 (UMLS CUI [2,1])
C0444930 (UMLS CUI [2,2])
End date unknown
Item
Not known
boolean
C0806020 (UMLS CUI [1,1])
C0439673 (UMLS CUI [1,2])
Disease persistent
Item
Persistent
boolean
C0012634 (UMLS CUI [1,1])
C0205322 (UMLS CUI [1,2])
Item Group
MSA History
C0393571 (UMLS CUI-1)
C0262926 (UMLS CUI-2)
Changes in MSA History since Screening visit (V0)
Item
Changes in MSA History since Screening visit (V0)
boolean
C0393571 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
MSA syncope
Item
Syncope
boolean
C0393571 (UMLS CUI [1,1])
C0039070 (UMLS CUI [1,2])
MSA Orthostatic hypotension
Item
Orthostatic hypotension
boolean
C0393571 (UMLS CUI [1,1])
C0020651 (UMLS CUI [1,2])
MSA Urinary Incontinence
Item
Urinary Incontinence
boolean
C0393571 (UMLS CUI [1,1])
C0042024 (UMLS CUI [1,2])
MSA Erectile Dysfuntion
Item
Erectile Dysfuntion
boolean
C0393571 (UMLS CUI [1,1])
C2733447 (UMLS CUI [1,2])
MSA Other autonomic symptoms
Item
Other (please specify)
text
C0393571 (UMLS CUI [1,1])
C2674101 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
MSA Bradykinesia
Item
Bradykinesia
boolean
C2733447 (UMLS CUI [1,1])
C3176307 (UMLS CUI [1,2])
MSA Rigidity
Item
Rigidity
boolean
C2733447 (UMLS CUI [1,1])
C0858572 (UMLS CUI [1,2])
MSA Tremor
Item
Tremor
boolean
C2733447 (UMLS CUI [1,1])
C0040822 (UMLS CUI [1,2])
Resting tremor
Item
Resting tremor
boolean
C0234379 (UMLS CUI [1])
Postural tremor
Item
Postural tremor
boolean
C0234378 (UMLS CUI [1])
MSA Other parkinsonism symptoms
Item
other (please specify)
text
C2733447 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
MSA Gait ataxia
Item
Gait ataxia
boolean
C2732311 (UMLS CUI [1,1])
C0751837 (UMLS CUI [1,2])
MSA limb ataxia
Item
Limb ataxia
boolean
C2732311 (UMLS CUI [1,1])
C4015302 (UMLS CUI [1,2])
MSA Other cerebellar symptoms
Item
Other (please specify)
text
C2732311 (UMLS CUI [1,1])
C0037088 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Current frequency of falls
integer
C1285588 (UMLS CUI [1])
Code List
Current frequency of falls
CL Item
several times per day (1)
CL Item
several times per week (2)
CL Item
several times per month (3)
CL Item
several times per year (4)
Item Group
Psychiatric history
C0748059 (UMLS CUI-1)
Psychiatric history
Item
Psychiatric history
boolean
C0748059 (UMLS CUI [1])
delusion
Item
Delusions
boolean
C0011253 (UMLS CUI [1])
Delsuions specify
Item
If yes, please specify
text
C0011253 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Hallucinations
Item
Hallucinations
boolean
C0018524 (UMLS CUI [1])
Hallucinations specify
Item
If yes, please specify.
text
C0018524 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Affective disorder
Item
Affective disorder
boolean
C0525045 (UMLS CUI [1])
Affective disorder specify
Item
If yes, please specify.
text
C0525045 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
psychiatric history other
Item
Other
boolean
C0748059 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Other psychiatric history specify
Item
If yes, please specify.
text
C0748059 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item Group
Concomitant medication
C2347852 (UMLS CUI-1)
Concomitant Medication
Item
Does the patient take any concomitant medication?
boolean
C2347852 (UMLS CUI [1])
Parkinson drugs
Item
Has the patient a stable regimen for at least one month for drugs acting against Parkinsonism.
boolean
C0003405 (UMLS CUI [1])
pharmaceutical preparation autonomic dysfunction
Item
Has the patient a stable regimen for at least one month for drugs acting against autonomic dysfunction.
boolean
C0013227 (UMLS CUI [1,1])
C3277919 (UMLS CUI [1,2])
antidepressant and antidementive drugs
Item
Has the patient a stable regimen for at least one month for antidepressant and antidementive drugs.
boolean
C0013227 (UMLS CUI [1,1])
C0003289 (UMLS CUI [1,2])
C0497327 (UMLS CUI [1,3])
Item Group
Vital signs
C0031809 (UMLS CUI-1)
Systolic Blood Pressure
Item
Systolic Blood Pressure
integer
C0871470 (UMLS CUI [1])
Diastolic blood pressure
Item
Diastolic blood pressure
integer
C0428883 (UMLS CUI [1])
Heart rate
Item
Heart rate
integer
C0018810 (UMLS CUI [1])
Body Temperature
Item
Temperature
integer
C0005903 (UMLS CUI [1])
Item Group
Physical examination
C0031809 (UMLS CUI-1)
Item
integer
C0031809 (UMLS CUI [1])
Code List
General physical examination
CL Item
normal (1)
CL Item
abnormal (please specify below) (2)
Item Group
Physical examination
C0031809 (UMLS CUI-1)
Item
Code
integer
C0031809 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
CL Item
Cardiovascular (01)
CL Item
Pulmonary (02)
CL Item
Abdominal (03)
CL Item
Genitourinary (04)
CL Item
Skeletal/Muscular (05)
CL Item
Psychiatric (06)
CL Item
other (07)
physical examination finding
Item
Finding
text
C0031809 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
Item Group
Neurological examination
C0027853 (UMLS CUI-1)
Item
Cranial nerves
integer
C0027853 (UMLS CUI [1,1])
C0558819 (UMLS CUI [1,2])
CL Item
normal (1)
CL Item
abnormal (2)
cranial nerves examination specify
Item
If abnormal, specify
text
C0027853 (UMLS CUI [1,1])
C0558819 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Motor function
integer
C0027853 (UMLS CUI [1,1])
C0234130 (UMLS CUI [1,2])
CL Item
normal (1)
CL Item
abnormal (2)
Motor function specify
Item
If abnormal, specify
text
C0027853 (UMLS CUI [1,1])
C0234130 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Reflexes
integer
C0027853 (UMLS CUI [1,1])
C0436145 (UMLS CUI [1,2])
CL Item
normal (1)
CL Item
abnormal (2)
Reflexes specify
Item
If abnormal, specify
text
C0027853 (UMLS CUI [1,1])
C0436145 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Coordination
integer
C0027853 (UMLS CUI [1,1])
C0242414 (UMLS CUI [1,2])
CL Item
normal (1)
CL Item
abnormal (2)
Coordination specify
Item
If abnormal, specify
text
C0027853 (UMLS CUI [1,1])
C0242414 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item
Sensation
integer
C0027853 (UMLS CUI [1,1])
C0036658 (UMLS CUI [1,2])
CL Item
normal (1)
CL Item
abnormal (2)
Sensation specify
Item
If abnormal, specify
text
C0027853 (UMLS CUI [1,1])
C0036658 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item Group
Pregnancy test
C0032976 (UMLS CUI-1)
Item
Pregnancy test
integer
C0032976 (UMLS CUI [1])
Code List
Pregnancy test
CL Item
positive (1)
CL Item
negative (2)
CL Item
not applicable (3)
Item Group
Laboratory test
C0022885 (UMLS CUI-1)
Date laboratory
Item
Date
date
C0011008 (UMLS CUI [1,1])
C0022885 (UMLS CUI [1,2])
Item Group
Laboratory test
C0022885 (UMLS CUI-1)
Item
Type of laboratory procedure
integer
C0022885 (UMLS CUI [1])
Code List
Type of laboratory procedure
CL Item
Erythrocytes T/L (1)
CL Item
Leukocytes G/L (2)
CL Item
Thrombocytes G/L (3)
CL Item
Hemoglobin g/dL (4)
CL Item
PTT sec (5)
CL Item
PchE kU/L (6)
CL Item
GOT (AST) U/L (7)
CL Item
GPT (ALT) U/L (8)
CL Item
Bilirubin mg/dL (9)
CL Item
Creatinine mg/dL (10)
CL Item
Creatine Kinase U/L (11)
CL Item
Potassium mmol/L (12)
CL Item
Sodium mmol/L (13)
CL Item
GFR mL/min (14)
CL Item
Iron ug/dL (15)
CL Item
Ferritin ng/mL (16)
CL Item
Transferrin g/dL (17)
CL Item
Albumine g/dL (18)
CL Item
Total protein g/dL (19)
Laboratory procedure value
Item
Value
float
C0587081 (UMLS CUI [1,1])
C0587081 (UMLS CUI [1,2])
Laboratory result normal
Item
Normal
boolean
C0587081 (UMLS CUI [1,1])
C0459422 (UMLS CUI [1,2])
Laboratory finding significant
Item
Clinical significant
boolean
C0456984 (UMLS CUI [1,1])
C0750502 (UMLS CUI [1,2])
Laboratory finding not significant
Item
Clinically not significant
boolean
C0587081 (UMLS CUI [1,1])
C2985739 (UMLS CUI [1,2])
Laboratory test not done
Item
Not done
boolean
C0022885 (UMLS CUI [1,1])
C0445106 (UMLS CUI [1,2])
Item Group
Unified MSA Rating scale - Part 1: Historical review
C0393571 (UMLS CUI-1)
C0681889 (UMLS CUI-2)
Item
Speech
integer
C0037817 (UMLS CUI [1])
Code List
Speech
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
0 (0)
Item
Swallowing
integer
C0392678 (UMLS CUI [1])
Code List
Swallowing
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Handwritting
integer
C0018582 (UMLS CUI [1])
Code List
Handwritting
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Cutting food and handling utensils
integer
C3639844 (UMLS CUI [1])
Code List
Cutting food and handling utensils
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Dressing
integer
C3639845 (UMLS CUI [1])
Code List
Dressing
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Hygiene
integer
C3639846 (UMLS CUI [1])
Code List
Hygiene
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Walking
integer
C0080331 (UMLS CUI [1])
Code List
Walking
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Falling
text
C3639848 (UMLS CUI [1])
Code List
Falling
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Orthostatic symptoms
integer
C3203485 (UMLS CUI [1])
Code List
Orthostatic symptoms
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Urinary function
integer
C0871563 (UMLS CUI [1])
Code List
Urinary function
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Sexual function
integer
C0260667 (UMLS CUI [1])
Code List
Sexual function
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Bowel function
integer
C1290944 (UMLS CUI [1])
Code List
Bowel function
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item Group
Unified MSA rating scale - Part 2: Motor examination scale
C0393571 (UMLS CUI-1)
C0681889 (UMLS CUI-2)
Item
Facial expression
integer
C0015457 (UMLS CUI [1])
Code List
Facial expression
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
integer
C0037817 (UMLS CUI [1])
Code List
Speech
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Ocular motor dysfunction
integer
C0234130 (UMLS CUI [1])
Code List
Ocular motor dysfunction
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Tremor at rest
integer
C0234379 (UMLS CUI [1])
Code List
Tremor at rest
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Action tremor
integer
C0234376 (UMLS CUI [1])
Code List
Action tremor
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Increased tone
integer
C0026841 (UMLS CUI [1])
Code List
Increased tone
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Rapid alternating movements of hands
integer
C3166247 (UMLS CUI [1,1])
C3166248 (UMLS CUI [1,2])
Code List
Rapid alternating movements of hands
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Finger taps
integer
C3827716 (UMLS CUI [1,1])
C3827717 (UMLS CUI [1,2])
Code List
Finger taps
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Leg agility
integer
C3827710 (UMLS CUI [1,1])
C3827711 (UMLS CUI [1,2])
Code List
Leg agility
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Heel-knee-skin test
integer
C0278160 (UMLS CUI [1])
Code List
Heel-knee-skin test
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Arising from chair
integer
C1290946 (UMLS CUI [1,1])
C3639721 (UMLS CUI [1,2])
Code List
Arising from chair
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Posture
integer
C0426976 (UMLS CUI [1])
Code List
Posture
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Body sway
integer
C0870214 (UMLS CUI [1])
Code List
Body sway
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Gait
integer
C0016928 (UMLS CUI [1])
Code List
Gait
CL Item
0  (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item Group
Unified MSA rating scale - Part 3: Autonomic examination
C0393571 (UMLS CUI-1)
C0681889 (UMLS CUI-2)
Item
Body position
integer
C1262869 (UMLS CUI [1])
Code List
Body position
CL Item
Supine (1)
CL Item
Standing (2min) (2)
Systolic Blood Pressure
Item
Systolic Blood Pressure
integer
C0871470 (UMLS CUI [1])
Diastolic blood pressure
Item
Diastolic blood pressure
integer
C0428883 (UMLS CUI [1])
Heart rate
Item
Heart rate
integer
C0018810 (UMLS CUI [1])
vital signs Unable to record
Item
Unable to record
boolean
C0518766 (UMLS CUI [1])
Item Group
Unified MSA rating scale - Part 4: Global disability scale
C0393571 (UMLS CUI-1)
C0681889 (UMLS CUI-2)
Item
Global disability scale
integer
C0451125 (UMLS CUI [1])
Code List
Global disability scale
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
Item Group
Clinical Global Impression (CGI)
C3639708 (UMLS CUI-1)
Item
Severity of illness
integer
C3639887 (UMLS CUI [1])
Code List
Severity of illness
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
Item Group
MRI at Baseline
C0024485 (UMLS CUI-1)
Item
MRI at Baseline
text
C0024485 (UMLS CUI [1,1])
C1442488 (UMLS CUI [1,2])
Code List
MRI at Baseline
CL Item
done  (1)
CL Item
not done (2)
Date of MRI
Item
Date of MRI
date
C0024485 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Study medication
C0013227 (UMLS CUI-1)
C0304229 (UMLS CUI-2)
Item
Trial medication distribution
integer
C3854006 (UMLS CUI [1,1])
C3469597 (UMLS CUI [1,2])
Code List
Trial medication distribution
CL Item
done  (1)
CL Item
not done (2)
Date of study drug distribution
Item
Date
date
C0011008 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C1512806 (UMLS CUI [1,3])
Number of Capsules dispensed
Item
Number of Capsules dispensed
integer
C0013227 (UMLS CUI [1,1])
C0805077 (UMLS CUI [1,2])
Planned medication start
Item
Planned medication start
date
C1521826 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Item Group
Signature of investigator
C2346576 (UMLS CUI-1)
Investigator Signature Date
Item
Date of Investigator Signature
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Investigator name
Item
Name of investigator
text
C2826892 (UMLS CUI [1])
Investigator signature
Item
Investigator signature
text
C2346576 (UMLS CUI [1])

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