CRF Cognition Module Baseline

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Date of visit
study id
Item
Study-ID:
text
C2826693 (UMLS CUI [1])
date of visit
Item
Date of visit
date
C1320303 (UMLS CUI [1])
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))
Item
2. Do you have difficulties seeing?
text
C3665347 (UMLS CUI [1])
difficulties seeing
Code List
2. Do you have difficulties seeing?
CL Item
No impairment (can see well with glasses on, fine print can be read without any problems) (No impairment (can see well with glasses on, fine print can be read without any problems))
CL Item
Compounded seeing (reading only possible with effort; fatiguing fast; only large type like headlines can be read without effort) (Compounded seeing (reading only possible with effort; fatiguing fast; only large type like headlines can be read without effort))
CL Item
Significant (severe impairment, e.g. cataract, recognize persons and objects, reading only with magnifier) (Significant (severe impairment, e.g. cataract, recognize persons and objects, reading only with magnifier))
CL Item
Severe visual impairment (only seeing shadows, only differing between light- and dark contrasts; blindness or almost blindness) (Severe visual impairment (only seeing shadows, only differing between light- and dark contrasts; blindness or almost blindness))
visus
Item
3. Visus measurement
float
C0042812 (UMLS CUI [1])
start of test
Item
Start of testing (time):
time
C0449244 (UMLS CUI [1])
initials of head of test
Item
Initials of head of test
text
C2986440 (UMLS CUI [1])
verbal fluency
Item
Verbal fluency: Category animals Total score
integer
C2121096 (UMLS CUI [1,1])
C0871945 (UMLS CUI [1,2])
Boston naming test
Item
Boston naming test Total score
integer
C0451037 (UMLS CUI [1])
Item
Please name version of word list:
text
C0456660 (UMLS CUI [1])
version of wordlist
Code List
Please name version of word list:
CL Item
Version 1 (Version 1)
CL Item
Version 2 (Version 2)
CL Item
Version 3 (Version 3)
first round of test right answers
Item
1. Round: No. of correct answers
integer
C0456984 (UMLS CUI [1,1])
C0456660 (UMLS CUI [1,2])
second round of test right answers
Item
2. Round: No. of correct answers
integer
C0456984 (UMLS CUI [1,1])
C0456660 (UMLS CUI [1,2])
third round of test right answers
Item
3. Round: No. of correct answers
integer
C0456984 (UMLS CUI [1,1])
C0456660 (UMLS CUI [1,2])
first round of test intrusion
Item
1. Round: No. intrusions
integer
C0456984 (UMLS CUI [1,1])
C0456660 (UMLS CUI [1,2])
second round of test intrusions
Item
2. Round: No. intrusions
integer
C0456984 (UMLS CUI [1,1])
C0456660 (UMLS CUI [1,2])
third round of test intrusions
Item
3. Round: No. of intrusions
integer
C0456984 (UMLS CUI [1,1])
C0456660 (UMLS CUI [1,2])
total score wordlist
Item
Total score
integer
figure drawing circle
Item
Drawing figures: Circle
integer
C0456984 (UMLS CUI [1,1])
C0204463 (UMLS CUI [1,2])
C1282913 (UMLS CUI [1,3])
drawing figures rhombus
Item
Drawing figures: Rhombus
integer
C0456984 (UMLS CUI [1,1])
C0204463 (UMLS CUI [1,2])
drawing figures rectangle
Item
Drawing figures: Rectangle
integer
C0204463 (UMLS CUI [1,1])
C0205142 (UMLS CUI [1,2])
drawing figures cube
Item
Drawing figures: Cube
integer
C0204463 (UMLS CUI [1,1])
C1880194 (UMLS CUI [1,2])
recalling wordlist
Item
Wordlist recall: Total number of correct answers
integer
C0456984 (UMLS CUI [1,1])
C0456660 (UMLS CUI [1,2])
recalling wordlist intrusions
Item
Recalling wordlist: Total number of intrusions
integer
C0456984 (UMLS CUI [1,1])
C0456660 (UMLS CUI [1,2])
total intrusions
Item
Intrusions total
integer
C0456984 (UMLS CUI [1,1])
C0456660 (UMLS CUI [1,2])
savings
Item
Savings
integer
recognizing wordlist
Item
Recognizing wordlist: No. recognized as old
integer
C0456984 (UMLS CUI [1,1])
C0456660 (UMLS CUI [1,2])
recognizing wordlist as new
Item
Recognizing wordlist: No. recognized as new
text
C0456984 (UMLS CUI [1,1])
C0456660 (UMLS CUI [1,2])
discriminability
Item
Discriminability
integer
recalling figures circle
Item
Recalling figures: Circle
integer
recalling figures rhombus
Item
Recalling figures: Rhombus
integer
recalling figures rectangle
Item
Recalling figures: Rectangle
integer
recalling figures cube
Item
Recalling figures: Cube
integer
recalling figures total
Item
Total
integer
recalling figures savings
Item
Savings
integer
phonematic fluency
Item
Total
integer
trail making test A
Item
TMT A time needed
integer
C0040604 (UMLS CUI [1])
trail making test B
Item
TMT B time needed
integer
C0040604 (UMLS CUI [1])
TMT
Item
TMT B/A
float
C0040604 (UMLS CUI [1])
WMS-R
Item
Range of numbers Correct rows forward
integer
C0451575 (UMLS CUI [1])
WMS-R backwards
Item
Correct rows backwards
integer
C0451575 (UMLS CUI [1])
MWT-B
Item
MWT-B Test: No. correct words
integer
brief test of attention numbers
Item
BTA- Form N (Numbers)
integer
brief test of attention letters
Item
BTA- Form L (letters)
integer
BTA total
Item
BTA total
integer
BTA z-value
Item
z-value
integer
VOSP
Item
Total raw value
integer
C0599621 (UMLS CUI [1])
VOSP pct
Item
Percentile
float
C0599621 (UMLS CUI [1])
finding similaraties
Item
Total raw value
integer
C2348205 (UMLS CUI [1])
finding similarities z-value
Item
z-value
float
C2348205 (UMLS CUI [1])
test person unmotivated
Item
The test person was not motivated enough
boolean
C0520941 (UMLS CUI [1])
test person refused tasks
Item
The test person refused to perform the tasks.
boolean
C1136454 (UMLS CUI [1])
test person physical problems
Item
The test person had physical problems like e.g. sensorial or motor impairment or pain obviously reducing test performance
boolean
C0421228 (UMLS CUI [1])
test person overchallenged
Item
The test person was cognitively over-challenged performing single task
boolean
C0338656 (UMLS CUI [1])
test person language problem
Item
The test person did not have adequate language knowledge
boolean
C0814953 (UMLS CUI [1])
specification comment
Item
If one question was answered 'Yes', please specify your answer:
text
C0947611 (UMLS CUI [1])
performance disturbed or interrupted
Item
The examination was disturbed or interrupted
boolean
C1512900 (UMLS CUI [1,1])
C0027902 (UMLS CUI [1,2])
performance deviation
Item
There were deviations from standard instruction
boolean
C0027902 (UMLS CUI [1,1])
C1705236 (UMLS CUI [1,2])
tasks not performed
Item
Tasks have not been performed.
boolean
C0027902 (UMLS CUI [1])
performance not conform
Item
The examination was not compliant to rules for other reasons.
boolean
C0027902 (UMLS CUI [1])
performance comment
Item
If one question was answered with 'Yes', please specify, which subtest the given details address and how to assess these.
text
C0947611 (UMLS CUI [1])
Item Group
Pill questionnaire
pill questionnaire not done
Item
not done
boolean
C0994475 (UMLS CUI [1,1])
C0034394 (UMLS CUI [1,2])
C1272696 (UMLS CUI [1,3])
participant knows names of pills
Item
Participant knows name of his pills?
boolean
C2360065 (UMLS CUI [1])
participant knows doses
Item
The participant knows in which doses to take the pills and the color of his pills.
boolean
C0178602 (UMLS CUI [1])
participant knows timetable of medications
Item
The participant knows the time table of his medication?
boolean
C3173975 (UMLS CUI [1])
correct answers part A
Item
Is the participant able to state medication name, doses or color of the pills and time of intake (3 times 'Yes') correctly?
boolean
part B1
Item
Is the participant able to correctly state time of intake and at least one of the following features name, dosis, pill color?
boolean
self-employed medication
Item
Does your relative take his medication totally independent and without control?
boolean
C0013227 (UMLS CUI [1,1])
C0085862 (UMLS CUI [1,2])
reminder for pill intake
Item
Does your relative have to be reminded to take his pills?
boolean
C0085519 (UMLS CUI [1])
problems because of wrong medication
Item
Were there ever any incidence when you had to consult a physician because your relative took his pills in a wrong way?
float
C1657765 (UMLS CUI [1])
conclusive assessment
Item
Was question 1 in section B2 answered 'Yes' and question 2 and 3 answered 'No'?
boolean
conclusive assessment part B1
Item
War section B1 answered 'Yes'?
boolean
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