Data Template For Initial Visit Packet

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1 NACC Uniform Data Set Data Template For Initial Visit Packet Version 3.0, March 2015 Copyright 2006, 2008, 2015, 2017 University of Washington. Created and published by the ADC Clinical Task Force (John C. Morris, MD, Chair) and the National Alzheimer s Coordinating Center (Walter A. Kukull, PhD, Director). All rights reserved. This publication was funded by the National Institutes of Health through the National Institute on Aging (Cooperative Agreement U01 AG016976).

2 Revisions made to this Data Template since UDS3 implementation (March 15, 2015) Date yyyy-mm-dd Description Form(s) affected Question(s) affected Data element(s) affected Form Z1 replaced by Form Z1X Z1 All Numerous variables added on language of administration Name of form changed from FAQ. All items and coding remain unchanged. B7 N/A N/A Missing entries for form header variables restored D2 N/A packet, formid

3 Data Template for NACC Uniform Data Set (UDS) Initial Visit Packet (IVP) This template is designed to help the ADC Data Cores develop software for submitting UDS data to NACC. The template details the data element names, type of data element, columns for ASCII file submission, and item number. This template is needed only for ASCII batch file submissions. Centers using web data entry will not need this template. A more detailed description of each data element is found in the data element dictionary. Data elements are listed by form and, within form, by item number. Please note: The first 10 data elements are the same for each template, for each form. They are required and are shaded on the template. They must have legal values, or the form cannot be processed. There is exactly one blank space required between the data fields of adjacent variables. Although a data field may in some cases contain one or more blanks, the required separator blank must still be included. Column assignments and column alignment must be maintained. In some cases, the item number in the template does not appear on the form. This is true for most Other (specify) text items and dates. Because there is more than one version of a given form in current use, make sure you are using the appropriate template. NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page i

4 Form Header elements The first 10 data elements in each form are: PACKET FORMID I (For the Initial Visit Packet) Form ID (i.e., Z1, A1, B4, etc.) FORMVER 3 (For this third version of all forms.) ADCID PTID Center ID (Same number used in the MDS and NP data for your Center; see the UDS Data Element Dictionary for a list of Center IDs.) Patient ID (Follow your Center s Patient ID scheme. Patient ID must be unique within the data set from your Center. For each subject, the PTID must be the same across all visits in the UDS. In addition, the same PTID used for that subject in the MDS and NP databases. PTID cannot change once it has been assigned by your Center. Since this is a character field, be sure to include/exclude leading zeroes to match ID numbers in all data sets.) VISITMO VISITDAY Actual date of the interview (Cannot precede 09/01/2005.) VISITYR VISITNUM INITIALS Visit ID (Assigned by your Center, need not start with 1.) Examiner initials (Initials of the person conducting the interview.) NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page ii

5 Form Z1X: Form Checklist Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 LANGA1 N 1a 1 47 LANGA2 N 2a 1 49 A2SUB N 2b A2NOT N 2c 1 54 LANGA3 N 3a 1 56 A3SUB N 3b A3NOT N 3c 1 61 LANGA4 N 4a 1 63 A4SUB N 4b A4NOT N 4c 1 68 LANGA5 N 5a 1 70 LANGB1 N 6a 1 72 B1SUB N 6b B1NOT N 6c 1 77 LANGB4 N 7a 1 79 LANGB5 N 8a 1 81 B5SUB N 8b B5NOT N 8c 1 86 LANGB6 N 9a 1 88 B6SUB N 9b NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 1

6 Variable B6NOT N 9c 1 93 LANGB7 N 10a 1 95 B7SUB N 10b B7NOT N 10c LANGB8 N 11a LANGB9 N 12a LANGC2 N 13a LANGD1 N 14a LANGD2 N 15a LANGA3A N 16a FTDA3AFS N 16b FTDA3AFR N 16c LANGB3F N 17a LANGB9F N 18a LANGC1F N 19a LANGC2F N 20a LANGC3F N 21a LANGC4F N 22a FTDC4FS N 22b FTDC4FR N 22c LANGC5F N 23a FTDC5FS N 23b FTDC5FR N 23c LANGC6F N 24a FTDC6FS N 24b FTDC6FR N 24c LANGE2F N 25a LANGE3F N 26a LANGCLS N 27a CLSSUB N 27b NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 2

7 Form A1: Subject Demographics Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 REASON N REFERSC N 2a 1 49 LEARNED N 2b 1 51 PRESTAT N PRESPART N SOURCENW N BIRTHMO N 6a BIRTHYR N 6b 1 65 SEX N HISPANIC N HISPOR N 8a HISPORX C 8a RACE N RACEX C 9a RACESEC N RACESECX C 10a RACETER N RACETERX C 11a PRIMLANG N PRIMLANX C 12a EDUC N MARISTAT N LIVSITUA N 15 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 3

8 Variable Form A1: Subject Demographics (cont.) INDEPEND N RESIDENC N ZIP C HANDED N 19 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 4

9 Form A2: Co participant Demographics Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C INBIRMO N 1a INBIRYR N 1b 1 53 INSEX N INHISP N INHISPOR N 3a INHISPOX C 3a INRACE N INRACEX C 4a INRASEC N INRASECX C 5a INRATER N INRATERX C 6a INEDUC N INRELTO N INKNOWN N 8a INLIVWTH N INVISITS N 9a INCALLS N 9b INRELY N 10 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 5

10 Form A3: Subject Family History Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C AFFFAMM N FADMUT N 2a FADMUTX C 2a FADMUSO N 2b FADMUSOX C 2b FFTDMUT N 3a FFTDMUTX C 3a FFTDMUSO N 3b FFTDMUSX C 3b FOTHMUT N 4a FOTHMUTX C 4a FOTHMUSO N 4b FOTHMUSX C 4b MOMMOB N 5a MOMYOB N 5a MOMDAGE N 5a MOMNEUR N 5a MOMPRDX N 5a MOMMOE N 5a MOMAGEO N 5a DADMOB N 5b DADYOB N 5b DADDAGE N 5b3 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 6

11 Variable Form A3: Subject Family History (cont.) DADNEUR N 5b DADPRDX N 5b DADMOE N 5b DADAGEO N 5b SIBS N SIB1MOB N 6a SIB1YOB N 6a SIB1AGD N 6a SIB1NEU N 6a SIB1PDX N 6a SIB1MOE N 6a SIB1AGO N 6a SIB2MOB N 6b SIB2YOB N 6b SIB2AGD N 6b SIB2NEU N 6b SIB2PDX N 6b SIB2MOE N 6b SIB2AGO N 6b SIB3MOB N 6c SIB3YOB N 6c SIB3AGD N 6c SIB3NEU N 6c SIB3PDX N 6c SIB3MOE N 6c SIB3AGO N 6c SIB4MOB N 6d SIB4YOB N 6d SIB4AGD N 6d SIB4NEU N 6d SIB4PDX N 6d SIB4MOE N 6d SIB4AGO N 6d SIB5MOB N 6e SIB5YOB N 6e2 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 7

12 Variable Form A3: Subject Family History (cont.) SIB5AGD N 6e SIB5NEU N 6e SIB5PDX N 6e SIB5MOE N 6e SIB5AGO N 6e SIB6MOB N 6f SIB6YOB N 6f SIB6AGD N 6f SIB6NEU N 6f SIB6PDX N 6f SIB6MOE N 6f SIB6AGO N 6f SIB7MOB N 6g SIB7YOB N 6g SIB7AGD N 6g SIB7NEU N 6g SIB7PDX N 6g SIB7MOE N 6g SIB7AGO N 6g SIB8MOB N 6h SIB8YOB N 6h SIB8AGD N 6h SIB8NEU N 6h SIB8PDX N 6h SIB8MOE N 6h SIB8AGO N 6h SIB9MOB N 6i SIB9YOB N 6i SIB9AGD N 6i SIB9NEU N 6i SIB9PDX N 6i SIB9MOE N 6i SIB9AGO N 6i SIB10MOB N 6j SIB10YOB N 6j2 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 8

13 Variable Form A3: Subject Family History (cont.) SIB10AGD N 6j SIB10NEU N 6j SIB10PDX N 6j SIB10MOE N 6j SIB10AGO N 6j SIB11MOB N 6k SIB11YOB N 6k SIB11AGD N 6k SIB11NEU N 6k SIB11PDX N 6k SIB11MOE N 6k SIB11AGO N 6k SIB12MOB N 6l SIB12YOB N 6l SIB12AGD N 6l SIB12NEU N 6l SIB12PDX N 6l SIB12MOE N 6l SIB12AGO N 6l SIB13MOB N 6m SIB13YOB N 6m SIB13AGD N 6m SIB13NEU N 6m SIB13PDX N 6m SIB13MOE N 6m SIB13AGO N 6m SIB14MOB N 6n SIB14YOB N 6n SIB14AGD N 6n SIB14NEU N 6n SIB14PDX N 6n SIB14MOE N 6n SIB14AGO N 6n SIB15MOB N 6o SIB15YOB N 6o2 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 9

14 Variable Form A3: Subject Family History (cont.) SIB15AGD N 6o SIB15NEU N 6o SIB15PDX N 6o SIB15MOE N 6o SIB15AGO N 6o SIB16MOB N 6p SIB16YOB N 6p SIB16AGD N 6p SIB16NEU N 6p SIB16PDX N 6p SIB16MOE N 6p SIB16AGO N 6p SIB17MOB N 6q SIB17YOB N 6q SIB17AGD N 6q SIB17NEU N 6q SIB17PDX N 6q SIB17MOE N 6q SIB17AGO N 6q SIB18MOB N 6r SIB18YOB N 6r SIB18AGD N 6r SIB18NEU N 6r SIB18PDX N 6r SIB18MOE N 6r SIB18AGO N 6r SIB19MOB N 6s SIB19YOB N 6s SIB19AGD N 6s SIB19NEU N 6s SIB19PDX N 6s SIB19MOE N 6s SIB19AGO N 6s SIB20MOB N 6t SIB20YOB N 6t2 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 10

15 Variable Form A3: Subject Family History (cont.) SIB20AGD N 6t SIB20NEU N 6t SIB20PDX N 6t SIB20MOE N 6t SIB20AGO N 6t KIDS N KID1MOB N 7a KID1YOB N 7a KID1AGD N 7a KID1NEU N 7a KID1PDX N 7a KID1MOE N 7a KID1AGO N 7a KID2MOB N 7b KID2YOB N 7b KID2AGD N 7b KID2NEU N 7b KID2PDX N 7b KID2MOE N 7b KID2AGO N 7b KID3MOB N 7c KID3YOB N 7c KID3AGD N 7c KID3NEU N 7c KID3PDX N 7c KID3MOE N 7c KID3AGO N 7c KID4MOB N 7d KID4YOB N 7d KID4AGD N 7d KID4NEU N 7d KID4PDX N 7d KID4MOE N 7d KID4AGO N 7d KID5MOB N 7e1 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 11

16 Variable Form A3: Subject Family History (cont.) KID5YOB N 7e KID5AGD N 7e KID5NEU N 7e KID5PDX N 7e KID5MOE N 7e KID5AGO N 7e KID6MOB N 7f KID6YOB N 7f KID6AGD N 7f KID6NEU N 7f KID6PDX N 7f KID6MOE N 7f KID6AGO N 7f KID7MOB N 7g KID7YOB N 7g KID7AGD N 7g KID7NEU N 7g KID7PDX N 7g KID7MOE N 7g KID7AGO N 7g KID8MOB N 7h KID8YOB N 7h KID8AGD N 7h KID8NEU N 7h KID8PDX N 7h KID8MOE N 7h KID8AGO N 7h KID9MOB N 7i KID9YOB N 7i KID9AGD N 7i KID9NEU N 7i KID9PDX N 7i KID9MOE N 7i KID9AGO N 7i KID10MOB N 7j1 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 12

17 Variable Form A3: Subject Family History (cont.) KID10YOB N 7j KID10AGD N 7j KID10NEU N 7j KID10PDX N 7j KID10MOE N 7j KID10AGO N 7j KID11MOB N 7k KID11YOB N 7k KID11AGD N 7k KID11NEU N 7k KID11PDX N 7k KID11MOE N 7k KID11AGO N 7k KID12MOB N 7l KID12YOB N 7l KID12AGD N 7l KID12NEU N 7l KID12PDX N 7l KID12MOE N 7l KID12AGO N 7l KID13MOB N 7m KID13YOB N 7m KID13AGD N 7m KID13NEU N 7m KID13PDX N 7m KID13MOE N 7m KID13AGO N 7m KID14MOB N 7n KID14YOB N 7n KID14AGD N 7n KID14NEU N 7n KID14PDX N 7n KID14MOE N 7n KID14AGO N 7n KID15MOB N 7o1 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 13

18 Variable Form A3: Subject Family History (cont.) KID15YOB N 7o KID15AGD N 7o KID15NEU N 7o KID15PDX N 7o KID15MOE N 7o KID15AGO N 7o7 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 14

19 Form A4G: Subject Medications (General) Variable 1 2 PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 ANYMEDS N 1 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 15

20 Form A4D: Subject Medications (Detail) Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C DRUGID C 1 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 16

21 Form A5: Subject Health History Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 TOBAC30 N 1a 1 47 TOBAC100 N 1b SMOKYRS N 1c 1 52 PACKSPER N 1d QUITSMOK N 1e 1 58 ALCOCCAS N 1f 1 60 ALCFREQ N 1g 1 62 CVHATT N 2a 1 64 HATTMULT N 2a HATTYEAR N 2a CVAFIB N 2b 1 73 CVANGIO N 2c 1 75 CVBYPASS N 2d 1 77 CVPACDEF N 2e 1 79 CVCHF N 2f 1 81 CVANGINA N 2g 1 83 CVHVALVE N 2h 1 85 CVOTHR N 2i CVOTHRX C 2i CBSTROKE N 3a STROKMUL N 3a STROKYR N 3a CBTIA N 3b NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 17

22 Variable Form A5: Subject Health History (cont.) TIAMULT N 3b TIAYEAR N 3b PD N 4a PDYR N 4a PDOTHR N 4b PDOTHRYR N 4b SEIZURES N 4c TBI N 4d TBIBRIEF N 4d TBIEXTEN N 4d TBIWOLOS N 4d TBIYEAR N 4d DIABETES N 5a DIABTYPE N 5a HYPERTEN N 5b HYPERCHO N 5c B12DEF N 5d THYROID N 5e ARTHRIT N 5f ARTHTYPE N 5f ARTHTYPX C 5f1a ARTHUPEX N 5f2a ARTHLOEX N 5f2b ARTHSPIN N 5f2c ARTHUNK N 5f2d INCONTU N 5g INCONTF N 5h APNEA N 5i RBD N 5j INSOMN N 5k OTHSLEEP N 5l OTHSLEEX C 5l ALCOHOL N 6a ABUSOTHR N 6b ABUSX C 6b1 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 18

23 Variable Form A5: Subject Health History (cont.) PTSD N 7a BIPOLAR N 7b SCHIZ N 7c DEP2YRS N 7d DEPOTHR N 7d ANXIETY N 7e OCD N 7f NPSYDEV N 7g PSYCDIS N 7h PSYCDISX C 7h1 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 19

24 Form B1: Physical Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C HEIGHT N WEIGHT N BPSYS N 3a BPDIAS N 3b HRATE N VISION N VISCORR N VISWCORR N 6a 1 72 HEARING N HEARAID N HEARWAID N 8a NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 20

25 Form B4: Global Staging Clinical Dementia Rating (CDR) Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C MEMORY N ORIENT N JUDGMENT N COMMUN N HOMEHOBB N PERSCARE N CDRSUM N CDRGLOB N COMPORT N CDRLANG N 10 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 21

26 Form B5: Neuropsychiatric Inventory Questionnaire (NPI Q) Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 NPIQINF N NPIQINFX C 1a DEL N 2a DELSEV N 2b HALL N 3a HALLSEV N 3b AGIT N 4a AGITSEV N 4b DEPD N 5a DEPDSEV N 5b ANX N 6a ANXSEV N 6b ELAT N 7a ELATSEV N 7b APA N 8a APASEV N 8b DISN N 9a DISNSEV N 9b IRR N 10a IRRSEV N 10b MOT N 11a MOTSEV N 11b NITE N 12a NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 22

27 Variable Form B5: Neuropsychiatric Inventory Questionnaire (cont.) NITESEV N 12b APP N 13a APPSEV N 13b NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 23

28 Form B6: Geriatric Depression Scale (GDS) Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 NOGDS N G SATIS N DROPACT N EMPTY N BORED N SPIRITS N AFRAID N HAPPY N HELPLESS N STAYHOME N MEMPROB N WONDRFUL N WRTHLESS N ENERGY N HOPELESS N BETTER N GDS N 16 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 24

29 Form B7: NACC Functional Assessment Scale (FAS) Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 BILLS N TAXES N SHOPPING N GAMES N STOVE N MEALPREP N EVENTS N PAYATTN N REMDATES N TRAVEL N 10 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 25

30 Form B8: Neurological Examination Findings Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 NORMEXAM N PARKSIGN N RESTTRL N 2a RESTTRR N 2a SLOWINGL N 2b SLOWINGR N 2b RIGIDL N 2c RIGIDR N 2c BRADY N 2d 1 63 PARKGAIT N 2e 1 65 POSTINST N 2f 1 67 CVDSIGNS N CORTDEF N 3a 1 71 SIVDFIND N 3b 1 73 CVDMOTL N 3c CVDMOTR N 3c CORTVISL N 3d CORTVISR N 3d SOMATL N 3e SOMATR N 3e POSTCORT N PSPCBS N EYEPSP N 5a NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 26

31 Variable Form B8: Neurological Examination Findings (cont.) 1 91 DYSPSP N 5b 1 93 AXIALPSP N 5c 1 95 GAITPSP N 5d 1 97 APRAXSP N 5e 1 99 APRAXL N 5f APRAXR N 5f CORTSENL N 5g CORTSENR N 5g ATAXL N 5h ATAXR N 5h ALIENLML N 5i ALIENLMR N 5i DYSTONL N 5j DYSTONR N 5j MYOCLLT N 5k MYOCLRT N 5k ALSFIND N GAITNPH N OTHNEUR N OTHNEURX C 8a NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 27

32 Form B9: Clinician Judgment of Symptoms Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 DECSUB N DECIN N DECCLCOG N COGMEM N 4a 1 53 COGORI N 4b 1 55 COGJUDG N 4c 1 57 COGLANG N 4d 1 59 COGVIS N 4e 1 61 COGATTN N 4f 1 63 COGFLUC N 4g COGFLAGO N 4g COGOTHR N 4h COGOTHRX C 4h COGFPRED N COGFPREX C 5a COGMODE N COGMODEX C 6a DECAGE N DECCLBE N BEAPATHY N 9a BEDEP N 9b BEVHALL N 9c BEVWELL N 9c1a NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 28

33 Variable Form B9: Clinician Judgment of Symptoms (cont.) BEVHAGO N 9c1b BEAHALL N 9c BEDEL N 9c BEDISIN N 9d BEIRRIT N 9e BEAGIT N 9f BEPERCH N 9g BEREM N 9h BEREMAGO N 9h BEANX N 9i BEOTHR N 9j BEOTHRX C 9j BEFPRED N BEFPREDX C 10a BEMODE N BEMODEX C 11a BEAGE N DECCLMOT N MOGAIT N 14a MOFALLS N 14b MOTREM N 14c MOSLOW N 14d MOFRST N MOMODE N MOMODEX C 16a MOMOPARK N PARKAGE N 17a MOMOALS N ALSAGE N 18a MOAGE N COURSE N FRSTCHG N LBDEVAL N FTLDEVAL N 23 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 29

34 Form C2: Neuropsychological Battery Scores (UDS3) Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 MOCACOMP N 1a MOCAREAS N 1a MOCALOC N 1b 1 52 MOCALAN N 1c MOCALANX C 1c MOCAVIS N 1d MOCAHEAR N 1e MOCATOTS N 1f MOCATRAI N 1g MOCACUBE N 1h MOCACLOC N 1i MOCACLON N 1j MOCACLOH N 1k MOCANAMI N 1l MOCAREGI N 1m MOCADIGI N 1n MOCALETT N 1o MOCASER7 N 1p MOCAREPE N 1q MOCAFLUE N 1r MOCAABST N 1s MOCARECN N 1t MOCARECC N 1u NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 30

35 Variable Form C2: Neuropsychological Battery Scores (cont.) MOCARECR N 1v MOCAORDT N 1w MOCAORMO N 1x MOCAORYR N 1y MOCAORDY N 1z MOCAORPL N 1aa MOCAORCT N 1bb NPSYCLOC N 2a NPSYLAN N 2b NPSYLANX C 2b CRAFTVRS N 3a CRAFTURS N 3b UDSBENTC N 4a DIGFORCT N 5a DIGFORSL N 5b DIGBACCT N 6a DIGBACLS N 6b ANIMALS N 7a VEG N 7b TRAILA N 8a TRAILARR N 8a TRAILALI N 8a TRAILB N 8b TRAILBRR N 8b TRAILBLI N 8b CRAFTDVR N 9a CRAFTDRE N 9b CRAFTDTI N 9c CRAFTCUE N 9d UDSBENTD N 10a UDSBENRS N 10b MINTTOTS N 11a MINTTOTW N 11b MINTSCNG N 11c MINTSCNC N 11d NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 31

36 Variable Form C2: Neuropsychological Battery Scores (cont.) MINTPCNG N 11e MINTPCNC N 11f UDSVERFC N 12a UDSVERFN N 12b UDSVERNF N 12c UDSVERLC N 12d UDSVERLR N 12e UDSVERLN N 12f UDSVERTN N 12g UDSVERTE N 12h UDSVERTI N 12i COGSTAT N 13a NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 32

37 Form D1: Clinician Diagnosis Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 DXMETHOD N NORMCOG N DEMENTED N AMNDEM N 4a 1 53 PCA N 4b 1 55 PPASYN N 4c 1 57 PPASYNT N 4c FTDSYN N 4d 1 61 LBDSYN N 4e 1 63 NAMNDEM N 4f 1 65 MCIAMEM N 5a 1 67 MCIAPLUS N 5b 1 69 MCIAPLAN N 5b MCIAPATT N 5b MCIAPEX N 5b MCIAPVIS N 5b MCINON1 N 5c 1 79 MCIN1LAN N 5c MCIN1ATT N 5c MCIN1EX N 5c MCIN1VIS N 5c MCINON2 N 5d 1 89 MCIN2LAN N 5d1 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 33

38 Variable Form D1: Clinician Diagnosis (cont.) 1 91 MCIN2ATT N 5d MCIN2EX N 5d MCIN2VIS N 5d IMPNOMCI N 5e 1 99 AMYLPET N 6a AMYLCSF N 6b FDGAD N 6c HIPPATR N 6d TAUPETAD N 6e CSFTAU N 6f FDGFTLD N 6g TPETFTLD N 6h MRFTLD N 6i DATSCAN N 6j OTHBIOM N 6k OTHBIOMX C 6k IMAGLINF N 7a IMAGLAC N 7b IMAGMACH N 7c IMAGMICH N 7d IMAGMWMH N 7e IMAGEWMH N 7f ADMUT N FTLDMUT N OTHMUT N OTHMUTX C 10a ALZDIS N ALZDISIF N 11a LBDIS N LBDIF N 12a PARK N 12b MSA N MSAIF N 13a PSP N 14a PSPIF N 14a1 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 34

39 Variable Form D1: Clinician Diagnosis (cont.) CORT N 14b CORTIF N 14b FTLDMO N 14c FTLDMOIF N 14c FTLDNOS N 14d FTLDNOIF N 14d FTLDSUBT N 14e FTLDSUBX C 14e CVD N CVDIF N 15a PREVSTK N 15b STROKDEC N 15b STKIMAG N 15b INFNETW N 15c INFWMH N 15d ESSTREM N ESSTREIF N 16a DOWNS N DOWNSIF N 17a HUNT N HUNTIF N 18a PRION N PRIONIF N 19a BRNINJ N BRNINJIF N 20a BRNINCTE N 20b HYCEPH N HYCEPHIF N 21a EPILEP N EPILEPIF N 22a NEOP N NEOPIF N 23a NEOPSTAT N 23b HIV N HIVIF N 24a OTHCOG N 25 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 35

40 Variable Form D1: Clinician Diagnosis (cont.) OTHCOGIF N 25a OTHCOGX C 25b DEP N DEPIF N 26a DEPTREAT N 26b BIPOLDX N BIPOLDIF N 27a SCHIZOP N SCHIZOIF N 28a ANXIET N ANXIETIF N 29a DELIR N DELIRIF N 30a PTSDDX N PTSDDXIF N 31a OTHPSY N OTHPSYIF N 32a OTHPSYX C 32b ALCDEM N ALCDEMIF N 33a ALCABUSE N 33b IMPSUB N IMPSUBIF N 34a DYSILL N DYSILLIF N 35a MEDS N MEDSIF N 36a COGOTH N COGOTHIF N 37a COGOTHX C 37b COGOTH2 N COGOTH2F N 38a COGOTH2X C 38b COGOTH3 N COGOTH3F N 39a COGOTH3X C 39b NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 36

41 Form D2: Clinician assessed Medical Conditions Variable PACKET C FORMID C FORMVER N ADCID N PTID C VISITMO N VISITDAY N VISITYR N VISITNUM C INITIALS C 1 45 CANCER N CANCSITE C 1a DIABET N MYOINF N CONGHRT N AFIBRILL N HYPERT N ANGINA N HYPCHOL N VB12DEF N THYDIS N ARTH N ARTYPE N 11a ARTYPEX C 11a ARTUPEX N 11b ARTLOEX N 11b ARTSPIN N 11b ARTUNKN N 11b URINEINC N BOWLINC N SLEEPAP N REMDIS N HYPOSOM N 16 NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 37

42 Variable Form D2: Clinician assessed Medical Conditions (cont.) SLEEPOTH N SLEEPOTX C 17a ANGIOCP N ANGIOPCI N PACEMAKE N HVALVE N ANTIENC N ANTIENCX C 22a OTHCOND N OTHCONDX C 23a NACC UDS Data Template for Initial Visit Packet (Version 3.0, March 2015) Page 38

NACC Uniform Data Set (UDS) DATA TEMPLATE for Initial Visit Packet (IVP)

NACC Uniform Data Set (UDS) DATA TEMPLATE for Initial Visit Packet (IVP) Department of Epidemiology, School of Public Health, University of Washington 4311 11 th Avenue NE #300 Seattle, WA 98105 phone: (206) 543-8637; fax: (206) 616-5927 e-mail: naccmail@u.washington.edu website: