==========================================================================================
Section DM: MEDICAL HISTORY - FOLLOW-UP VISIT (Respondent)
==========================================================================================
HHID HRS HOUSEHOLD IDENTIFIER
Section: DM Level: Respondent Type: Character Width: 6 Decimals: 0
This variable uniquely identifies an original HRS household across waves.
.................................................................................
217 010059-213467. Household Identification Number
==========================================================================================
PN HRS PERSON NUMBER IDENTIFIER
Section: DM Level: Respondent Type: Character Width: 3 Decimals: 0
Each HRS respondent has a Person Number, PN, unique within an original
household. In combination, HHID and PN uniquely identify a respondent across
all waves of the study.
.................................................................................
131 010. Person Number
4 011. Person Number
55 020. Person Number
16 030. Person Number
11 040. Person Number
041. Person Number
==========================================================================================
ADAMSSID ADAMS SUBJECT IDENTIFIER
Section: DM Level: Respondent Type: Character Width: 5 Decimals: 0
This variable identifies an ADAMS subject in the ADAMS data files.
.................................................................................
217 00111-21271. ADAMS Subject Identification Number
==========================================================================================
DMCOMP WHETHER MEDICAL HISTORY COMPLETED
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MHDONE
Medical History Completed?
.................................................................................
216 1. Yes
1 5. No
==========================================================================================
DMSPAN MEDICAL HISTORY CONDUCTED IN SPANISH
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MHSPAN
Medical History completed in Spanish?
.................................................................................
1. YES
217 Blank. Inap
==========================================================================================
DM1 SEEN DOCTOR FOR MEMORY PROBLEMS SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH1
The next few questions are about (NAME's) medical history. Since we last
visited (him/her), has (NAME) seen a doctor for any of the memory problems we
have discussed? (If no memory problems endorsed, ask if subject has seen a
doctor for any concerns with (her/his) memory or thinking?).
.................................................................................
7 1. Yes
206 5. No
97. Not Asked/Not Assessed
3 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM3 SPECIALTY OF DOCTOR IN CM1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH3
Doctor Specialty:
.................................................................................
1 1. Neurologist
2. Psychiatrist
4 3. Family Practice/General/Internal Medicine
4. Geriatrician
1 7. Other (Specify)
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
210 Blank. Inap
==========================================================================================
DM4MO MONTH OF MEMORY PROBLEM EXAM
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH4MO
Date of Exam: (MONTH)
.................................................................................
1 1. January
2. February
3. March
4. April
5. May
6. June
7. July
1 8. August
9. September
10. October
1 11. November
12. December
4 98. DK (Don't Know)
210 Blank. Inap
==========================================================================================
DM4YR YEAR OF MEMORY PROBLEM EXAM
Section: DM Level: Respondent Type: Numeric Width: 4 Decimals: 0
Ref: MH4YR
Date of Exam: (YEAR)
.................................................................................
1930-1949. YEAR
1950-1969. YEAR
1970-1979. YEAR
1980-1989. YEAR
1990-1999. YEAR
6 2000-2009. YEAR
1 9998. DK (Don't Know)
210 Blank. Inap
==========================================================================================
DM5 WHAT DID DR SAY WAS CAUSE OF MEM TROUBLE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH5
What did the doctor say was the cause of the memory trouble?
.................................................................................
1 1. Normal Aging
2. Alzheimer's Disease
2 3. VaD, Strokes or TIAs
3 4. Dementia
5. Parkinson's Disease
6. Depression
1 7. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
210 Blank. Inap
==========================================================================================
DM6 HAVE AN EXAM WITH SPECIALIST SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH6
If doctor in #2 is not a specialist or if doctor in #2 is a specialist and
respondent saw a 2nd specialist, ask 'Since we last visited (NAME), has (s/he)
had an examination with a specialist such as a neurologist or psychiatrist for
memory problems?'
.................................................................................
1 1. Yes
4 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
211 Blank. Inap
==========================================================================================
DM8 SPECIALTY OF DOCTOR MENTIONED IN CM6
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH8
Doctor Specialty:
.................................................................................
1. Neurologist
2. Psychiatrist
3. Family Practice/General/Internal Medicine
4. Geriatrician
1 7. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM8MO MONTH OF SPECIALIST EXAM
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH8MO
Date of Exam: (MONTH)
.................................................................................
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
1 98. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM8YR YEAR OF SPECIALIST EXAM
Section: DM Level: Respondent Type: Numeric Width: 4 Decimals: 0
Ref: MH8YR
Date of Exam: (YEAR)
.................................................................................
1930-1949. YEAR
1950-1969. YEAR
1970-1979. YEAR
1980-1989. YEAR
1990-1999. YEAR
1 2000-2009. YEAR
9998. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM9 DIAGNOSIS SPECIALIST GAVE FOR MEM PXS
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH9
What diagnosis was given for the cause of the problems?
.................................................................................
1. Normal Aging
2. Alzheimer's Disease
3. VaD, Strokes or TIAs
1 4. Dementia
5. Parkinson's Disease
6. Depression
7. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM10 IF HAD MEM EVALUATION, WAS LAB WORK DONE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH10
If memory evaluation done ask 'Since we last visited (him/her) was any lab work
(blood work, urinalysis, EEG, etc) done as a part of the memory evaluation?'
.................................................................................
1 1. Yes
2 5. No
1 97. Not Asked/Not Assessed
3 98. DK (Don't Know)
99. RF (Refused)
210 Blank. Inap
==========================================================================================
DM10AMO MONTH OF LAB WORK
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH10AMO
If memory evaluation done ask 'Was any lab work (blood work, urinalysis, EEG,
etc) done?' Date of labwork: (MONTH)
.................................................................................
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
1 98. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM10AYR YEAR OF LAB WORK
Section: DM Level: Respondent Type: Numeric Width: 4 Decimals: 0
Ref: MH10AYR
If memory evaluation done ask 'Was any lab work (blood work, urinalysis, EEG,
etc) done?' Date of labwork: (YEAR)
.................................................................................
1930-1949. YEAR
1950-1969. YEAR
1970-1979. YEAR
1980-1989. YEAR
1990-1999. YEAR
2000-2009. YEAR
1 9998. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM10RES RESULTS OF LAB WORK
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH10RES
If memory evaluation done ask 'Was any lab work (blood work, urinalysis, EEG,
etc) done?' RESULTS:
.................................................................................
1. Normal
2. Abnormal(Specify)
1 97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM11 HAD A CT SCAN OR MRI OF THE HEAD SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH11
Since we last visited (him/her), has (s/he) had a CT scan or MRI of the head
done?
.................................................................................
15 1. Yes
190 5. No
97. Not Asked/Not Assessed
11 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM13MO MONTH OF CT SCAN OR MRI
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH13MO
Date of CT scan or MRI: (MONTH)
.................................................................................
3 1. January
2 2. February
1 3. March
4. April
5. May
6. June
3 7. July
1 8. August
9. September
1 10. October
2 11. November
1 12. December
1 98. DK (Don't Know)
202 Blank. Inap
==========================================================================================
DM13YR YEAR OF CT SCAN OR MRI
Section: DM Level: Respondent Type: Numeric Width: 4 Decimals: 0
Ref: MH13YR
Date of CT scan or MRI: (YEAR)
.................................................................................
1930-1949. YEAR
1950-1969. YEAR
1970-1979. YEAR
1980-1989. YEAR
1990-1999. YEAR
15 2000-2009. YEAR
9998. DK (Don't Know)
202 Blank. Inap
==========================================================================================
DM14 RESULTS OF CT SCAN OR MRI
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH14
What were the results of the CT scan or MRI?
.................................................................................
10 1. Normal
3 2. Abnormal(Specify)
97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
202 Blank. Inap
==========================================================================================
DM14CODE CODE SPECIFY IF ABNORMAL FOR CM14
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH14CODE
.................................................................................
1. Alzheimer's Disease
1 2. Dementia
2 3. Stroke/possible stroke/TIA/mini-strokes
4. Hydrocephaly/brain damage/shrinkage/atrophy/deterioration
5. Brain tumor/brain cancer/lesion
6. Parkinson's Disease
7. White matter/white matter change
8. Aneurysm
9. Nasal/sinus/ear/throat issues, including cancer
10. Head injury/trauma
11. Spinal issues
12. Artery blockage/poor circulation/hardening, narrowing, or
inflammation of arteries/blood
clots/hematoma/infarcts/ischema/hemmorage/other heart or
cardiac related issues
13. Hematoma
14. Non-CNS cancer
15. Other (specify) use the text field as the specify
16. Inconclusive
214 Blank. Inap
==========================================================================================
DM16 TOLD BY DR HAD PARKINSON'S DISEASE SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH16
Since we last visited (him/her), has a doctor told (NAME) that (s/he) has
Parkinson's Disease or has (s/he) been treated for Parkinson's disease?
.................................................................................
2 1. Yes
212 5. No
97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM17 AGE WHEN TOLD HAD PARKINSON'S DISEASE
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH17
How old was (s/he) when (s/he) was told (s/he) had Parkinson's Disease?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
2 70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
215 Blank. Inap
==========================================================================================
DM18 TAKEN PD MEDICATIONS SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH18
Has (s/he) ever taken L-DOPA, Sinemet, Mirapex, Requip, Permax, Amantadine,
Symmetrel, Selegiline, Eldepryl, Comtan, or Parlodel?
.................................................................................
2 1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM19 DID PD SYMPTOMS IMPROVE WITH MEDICINE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH19
Did the symptoms improve after starting the medicine?
.................................................................................
1. Yes
1 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM20 TAKEN ANY OTHER MEDICATION FOR PD SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH20
Has (s/he) ever taken any other medications for Parkinson's Disease?
.................................................................................
1. Yes
2 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM21 DID PD SYMPTOMS IMPROVE WITH MEDICINE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH21
Did the symptoms improve after starting the medicine?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM23 MEM PXS START BEFORE, IMM AFTER, LAT AFTER PD
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH23
To the best of your recollection, did the memory problems start
before,immediately after, or some time later after being told (s/he) has
Parkinson's disease?
.................................................................................
1 1. Before
2. Immediately After
3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM25 TOLD BY DOCTOR HAD STROKE SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH25
Since we last visited (him/her), has (NAME) been told by a doctor or a nurse
that (s/he) had a stroke?
.................................................................................
2 1. Yes
213 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM26 HAD MORE THAN ONE STROKE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH26
Has (s/he) had more than one stroke?
.................................................................................
1. Yes
2 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM27 HOW MANY STROKES
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH27
How many strokes during this time (since the last visit)?
.................................................................................
1-5. Number
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM28MO MONTH OF FIRST STROKE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH28MO
When did the [first] stroke take place during this time (since the last visit)?
(MONTH)
.................................................................................
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM28YR YEAR OF FIRST STROKE
Section: DM Level: Respondent Type: Numeric Width: 4 Decimals: 0
Ref: MH28YR
When did the [first] stroke take place during this time (since the last visit)?
(YEAR)
.................................................................................
1930-1949. YEAR
1950-1969. YEAR
1970-1979. YEAR
1980-1989. YEAR
1990-1999. YEAR
2000-2009. YEAR
9998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM28AGE AGE OF FIRST STROKE
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH28AGE
When did the [first] stroke take place during this time (since the last visit)?
(AGE)
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
1 70-79. AGE
80-89. AGE
1 90-99. AGE
100-109. AGE
998. DK (Don't Know)
215 Blank. Inap
==========================================================================================
DM29 WHETHER ADMITTED TO HOSPITAL FOR STROKE 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH29
Was (s/he) admitted to a hospital for this stroke?
.................................................................................
2 1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM31 DID ONE SIDE BECOME WEAKER WITH STROKE 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH31
Did one side of (NAME's) body, or one arm/leg become weaker than the other side,
as a result of the stroke?
.................................................................................
1. Yes
2 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM32 WHICH SIDE BECAME WEAKER WITH STROKE 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH32
Which side?
.................................................................................
1. Left
2. Right
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM33NUM DURATION (NUMBER) FOR SYMPTOMS IN CM31
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH33NUM
How long did the problem last? (Number Duration)
.................................................................................
1-5. Number
6-10. Number
11-95. Number
97. Not Asked/Not Assessed
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM33DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM31
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH33DUR
How long did the problem last? (Timeframe Duration)
.................................................................................
1. Hours
2. Days
3. Months
4. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM34 PXS WITH ANY OTHER PART OF BODY-STROKE 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH34
Did (s/he) experience problems with any other part of (her/his) body?
.................................................................................
1 1. Yes
1 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM35 WHICH PART HAD PROBLEMS-STROKE 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH35
Which part?
.................................................................................
1 1. Face
2. Arm
3. Leg
7. Other(Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM36NUM DURATION (NUMBER) FOR SYMPTOMS IN CM34
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH36NUM
How long did these problems last? (Number Duration)
.................................................................................
1 1-5. Number
97. Not Asked/Not Assessed
98. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM36DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM34
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH36DUR
How long did these problems last? (Time Duration)
.................................................................................
1. Hours
1 2. Days
3. Months
4. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM37 SPEECH/LANGUAGE PROBLEMS WITH STROKE 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH37
Did (s/he) experience any speech or language problems (slurring etc.)
.................................................................................
1 1. Yes
1 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM38NUM DURATION (NUMBER) FOR SYMPTOMS IN CM37
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH38NUM
How long did these problems last? (Number Duration)
.................................................................................
1 1-5. Number
6-10. Number
11-95. Number
97. Not Asked/Not Assessed
98. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM38DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM37
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH38DUR
How long did these problems last? (Timeframe Duration)
.................................................................................
1. Hours
1 2. Days
3. Months
4. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM39 MEM PXS START BEFORE/IMM AFT/LAT AFT STROKE 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH39
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after the stroke?
.................................................................................
1 1. Before
2. Immediately After
3. Later After
1 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM41MO MONTH OF SECOND STROKE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH41MO
When did the second stroke take place? (MONTH)
.................................................................................
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM41YR YEAR OF SECOND STROKE
Section: DM Level: Respondent Type: Numeric Width: 4 Decimals: 0
Ref: MH41YR
When did the second stroke take place? (YEAR)
.................................................................................
1930-1949. YEAR
1950-1969. YEAR
1970-1979. YEAR
1980-1989. YEAR
1990-1999. YEAR
2000-2009. YEAR
9998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM41AGE AGE OF SECOND STROKE
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH41AGE
When did the second stroke take place? (AGE)
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM42 WHETHER ADMITTED TO HOSPITAL FOR STROKE 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH42
Was (s/he) admitted to a hospital for this stroke?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM44 DID ONE SIDE BECOME WEAKER WITH STROKE 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH44
Did one side of (NAME's) body, or one arm/leg become weaker than the other side,
as a result of the stroke?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM45 WHICH SIDE BECAME WEAKER WITH STROKE 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH45
Which side?
.................................................................................
1. Left
2. Right
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM46NUM DURATION (NUMBER) FOR SYMPTOMS IN CM44
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH46NUM
How long did the problem last? (Number Duration)
.................................................................................
97. Not Asked/Not Assessed
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM46DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM44
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH46DUR
How long did the problem last? (Timeframe Duration)
.................................................................................
1. Hours
2. Days
3. Months
4. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM47 PXS WITH ANY OTHER PART OF BODY-STROKE 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH47
Did (s/he) experience problems with any other part of (her/his) body?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM48 WHICH PART HAD PROBLEMS-STROKE 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH48
Which part?
.................................................................................
1. Face
2. Arm
3. Leg
7. Other(Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM49NUM DURATION (NUMBER) FOR SYMPTOMS IN CM47
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH49NUM
How long did these problems last? (Number Duration)
.................................................................................
97. Not Asked/Not Assessed
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM49DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM47
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH49DUR
How long did these problems last? (Timeframe Duration)
.................................................................................
1. Hours
2. Days
3. Months
4. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM50 SPEECH/LANGUAGE PROBLEMS WITH STROKE 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH50
Did (s/he) experience any speech or language problems (slurring etc.)
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM51NUM DURATION (NUMBER) FOR SYMPTOMS IN CM50
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH51NUM
How long did these problems last? (Number Duration)
.................................................................................
97. Not Asked/Not Assessed
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM51DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM50
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH51DUR
How long did these problems last? (Timeframe Duration)
.................................................................................
1. Hours
2. Days
3. Months
4. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM52 MEM PXS START BEFORE/IMM AFT/LAT AFT STROKE 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH52
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after the stroke?
.................................................................................
1. Before
2. Immediately After
3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM54MO MONTH OF THIRD STROKE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH54MO
When did the third stroke take place? (MONTH)
.................................................................................
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM54YR YEAR OF THIRD STROKE
Section: DM Level: Respondent Type: Numeric Width: 4 Decimals: 0
Ref: MH54YR
When did the third stroke take place? (YEAR)
.................................................................................
1930-1949. YEAR
1950-1969. YEAR
1970-1979. YEAR
1980-1989. YEAR
1990-1999. YEAR
2000-2009. YEAR
9998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM54AGE AGE OF THIRD STROKE
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH54AGE
When did the third stroke take place? (AGE)
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM55 WHETHER ADMITTED TO HOSPITAL FOR STROKE 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH55
Was (s/he) admitted to a hospital for this stroke?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM57 DID ONE SIDE BECOME WEAKER WITH STROKE 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH57
Did one side of (NAME's) body, or one arm/leg become weaker than the other side,
as a result of the stroke?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM58 WHICH SIDE BECAME WEAKER WITH STROKE 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH58
Which side?
.................................................................................
1. Left
2. Right
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM59NUM DURATION (NUMBER) FOR SYMPTOMS IN CM57
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH59NUM
How long did the problem last? (Number Duration)
.................................................................................
97. Not Asked/Not Assessed
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM59DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM57
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH59DUR
How long did the problem last? (Timeframe Duration)
.................................................................................
1. Hours
2. Days
3. Months
4. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM60 PXS WITH ANY OTHER PART OF BODY-STROKE 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH60
Did (s/he) experience problems with any other part of (her/his) body?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM61 WHICH PART HAD PROBLEMS-STROKE 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH61
Which part?
.................................................................................
1. Face
2. Arm
3. Leg
7. Other(Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM62NUM DURATION (NUMBER) FOR SYMPTOMS IN CM60
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH62NUM
How long did these problems last? (Number Duration)
.................................................................................
97. Not Asked/Not Assessed
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM62DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM60
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH62DUR
How long did these problems last? (Timeframe Duration)
.................................................................................
1. Hours
2. Days
3. Months
4. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM63 SPEECH/LANGUAGE PROBLEMS WITH STROKE 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH63
Did (s/he) experience any speech or language problems (slurring etc.)
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM64NUM DURATION (NUMBER) FOR SYMPTOMS IN CM63
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH64NUM
How long did these problems last? (Number Duration)
.................................................................................
97. Not Asked/Not Assessed
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM64DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM63
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH64DUR
How long did these problems last? (Timeframe Duration)
.................................................................................
1. Hours
2. Days
3. Months
4. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM65 MEM PXS START BEFORE/IMM AFT/LAT AFT STROKE 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH65
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after the stroke?
.................................................................................
1. Before
2. Immediately After
3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM67MO MONTH OF FOURTH STROKE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH67MO
When did the fourth stroke take place? (MONTH)
.................................................................................
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM67YR YEAR OF FOURTH STROKE
Section: DM Level: Respondent Type: Numeric Width: 4 Decimals: 0
Ref: MH67YR
When did the fourth stroke take place? (YEAR)
.................................................................................
1930-1949. YEAR
1950-1969. YEAR
1970-1979. YEAR
1980-1989. YEAR
1990-1999. YEAR
2000-2009. YEAR
9998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM67AGE AGE OF FOURTH STROKE
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH67AGE
When did the fourth stroke take place? (AGE)
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM68 WHETHER ADMITTED TO HOSPITAL FOR STROKE 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH68
Was (s/he) admitted to a hospital for this stroke?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM70 DID ONE SIDE BECOME WEAKER WITH STROKE 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH70
Did one side of (NAME's) body, or one arm/leg become weaker than the other side,
as a result of the stroke?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM71 WHICH SIDE BECAME WEAKER WITH STROKE 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH71
Which side?
.................................................................................
1. Left
2. Right
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM72NUM DURATION (NUMBER) FOR SYMPTOMS IN CM70
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH72NUM
How long did the problem last? (Number Duration)
.................................................................................
97. Not Asked/Not Assessed
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM72DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM70
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH72DUR
How long did the problem last? (Timeframe Duration)
.................................................................................
1. Hours
2. Days
3. Months
4. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM73 PXS WITH ANY OTHER PART OF BODY-STROKE 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH73
Did (s/he) experience problems with any other part of(her/his) body?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM74 WHICH PART HAD PROBLEMS-STROKE 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH74
Which part?
.................................................................................
1. Face
2. Arm
3. Leg
7. Other(Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM75NUM DURATION (NUMBER) FOR SYMPTOMS IN CM73
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH75NUM
How long did these problems last? (Number Duration)
.................................................................................
97. Not Asked/Not Assessed
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM75DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM73
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH75DUR
How long did these problems last? (Timeframe Duration)
.................................................................................
1. Hours
2. Days
3. Months
4. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM76 SPEECH/LANGUAGE PROBLEMS WITH STROKE 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH76
Did (s/he) experience any speech or language problems (slurring etc.)?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM77NUM DURATION (NUMBER) FOR SYMPTOMS IN CM76
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH77NUM
How long did these problems last? (Number Duration)
.................................................................................
97. Not Asked/Not Assessed
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM77DUR DURATION (TIMEFRAME) FOR SYMPTOMS IN CM76
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH77DUR
How long did these problems last? (Timeframe Duration)
.................................................................................
1. Before
2. Immediately After
3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM78 MEM PXS START BEFORE/IMM AFT/LAT AFT STROKE 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH78
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after the stroke?
.................................................................................
1. Before
2. Immediately After
3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM80 PROBLEMS WALKING OR CHANGE SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH80
Since we last visited (him/her) has (s/he) had problems walking or has (her/his)
gait (pattern of walking) changed?
.................................................................................
115 1. Yes
101 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM81MO MONTH WALKING PROBLEMS BEGAN
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH81MO
When did this start? (MONTH)
.................................................................................
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM81YR YEAR WALKING PROBLEMS BEGAN
Section: DM Level: Respondent Type: Numeric Width: 4 Decimals: 0
Ref: MH81YR
When did this start? (YEAR)
.................................................................................
1930-1949. YEAR
1950-1969. YEAR
1970-1979. YEAR
1980-1989. YEAR
1990-1999. YEAR
2000-2009. YEAR
9998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM81AGE AGE WALKING PROBLEMS BEGAN
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH81AGE
When did this start? (AGE)
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
1 40-49. AGE
1 50-59. AGE
2 60-69. AGE
40 70-79. AGE
48 80-89. AGE
15 90-99. AGE
100-109. AGE
8 998. DK (Don't Know)
102 Blank. Inap
==========================================================================================
DM82 TYPE OF WALKING PROBLEM
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH82
Describe the type of problem s/he has walking and/or how his/her gait has
changed:
.................................................................................
1 1. Shuffling Gait
1 2. Problems Initiating Gait
33 3. Balance Problems or Unsteady Gait
10 4. Tires Easily
47 5. Pain
1 6. Hemiparesis
6 7. Uses walker or cane
6 8. Limps
10 9. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
102 Blank. Inap
==========================================================================================
DM84 HAS DOCTOR SAID WHAT CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH83
Has a doctor said what might have caused the problems with walking or the change
in his/her/gait?
.................................................................................
72 1. Yes
42 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
102 Blank. Inap
==========================================================================================
DM84_1 ARTHRITIS CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_1
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
ARTHRITIS
.................................................................................
182 0. No
35 1. Yes
==========================================================================================
DM84_2 STROKES/TIAS CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_2
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
STROKES/TIAS
.................................................................................
216 0. No
1 1. Yes
==========================================================================================
DM84_3 PD CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_3
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
PD
.................................................................................
216 0. No
1 1. Yes
==========================================================================================
DM84_4 HIP PROBLEMS/SURGERY CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_4
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
HIP PROBLEMS/SURGERY
.................................................................................
210 0. No
7 1. Yes
==========================================================================================
DM84_5 KNEE PROBLEMS/SURGERY CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_5
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
KNEE PROBLEMS/SURGERY
.................................................................................
207 0. No
10 1. Yes
==========================================================================================
DM84_6 BACK PAIN/PROBLEMS CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_6
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
BACK PAIN/PROBLEMS
.................................................................................
202 0. No
15 1. Yes
==========================================================================================
DM84_7 POOR BALANCE CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_7
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
POOR BALANCE
.................................................................................
216 0. No
1 1. Yes
==========================================================================================
DM84_8 EDEMA/POOR CIRCULATION CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_8
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
EDEMA/POOR CIRCULATION
.................................................................................
212 0. No
5 1. Yes
==========================================================================================
DM84_9 PERIPHERAL NEUROPATHY CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_9
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
PERIPHERAL NEUROPATHY
.................................................................................
215 0. No
2 1. Yes
==========================================================================================
DM84_10 AMPUTATION CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_10
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
AMPUTATION
.................................................................................
216 0. No
1 1. Yes
==========================================================================================
DM84_11 DEMENTIA CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_11
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
DEMENTIA
.................................................................................
217 0. No
1. Yes
==========================================================================================
DM84_12 GENERALIZED WEAKNESS CAUSED GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_12
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
GENERALIZED WEAKNESS
.................................................................................
217 0. No
1. Yes
==========================================================================================
DM84_13 OTHER CAUSE GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_13
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
OTHER (Specify)
.................................................................................
203 0. No
14 1. Yes
==========================================================================================
DM84_97 NOT ASKED/NOT ASSESSED CAUSE GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_97
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
NOT ASKED/NOT ASSESSED
.................................................................................
217 0. No
==========================================================================================
DM84_98 DK CAUSE GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_98
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
DK
.................................................................................
216 0. No
1 1. Yes
==========================================================================================
DM84_99 RF CAUSE GAIT CHANGE
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH84_99
What did doctor say was the cause? [MARK UP TO 2 KEY CAUSES]
RF
.................................................................................
217 0. No
==========================================================================================
DM87 HAD PROBLEMS WITH FALLING SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH86
Since we last visited (him/her) has (NAME) had problems with falling?
.................................................................................
46 1. Yes
169 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM88 HOW FREQUENTLY DOES SUBJECT FALL
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH87
How frequently does (s/he) fall?
.................................................................................
5 1. More than 1/Month
15 2. 1/Month or Less than 1/Month
25 3. Less than 1/Year
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
171 Blank. Inap
==========================================================================================
DM89MO MONTH WHEN FALLING PROBLEM BEGAN
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH88MO
When did this falling problem start? (MONTH)
.................................................................................
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM89YR YEAR WHEN FALLING PROBLEM BEGAN
Section: DM Level: Respondent Type: Numeric Width: 4 Decimals: 0
Ref: MH88YR
When did this falling problem start? (YEAR)
.................................................................................
1930-1949. YEAR
1950-1969. YEAR
1970-1979. YEAR
1980-1989. YEAR
1990-1999. YEAR
2000-2009. YEAR
9998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM89AGE AGE WHEN FALLING PROBLEM BEGAN
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH88AGE
When did this falling problem start? (AGE)
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
13 70-79. AGE
25 80-89. AGE
6 90-99. AGE
100-109. AGE
2 998. DK (Don't Know)
171 Blank. Inap
==========================================================================================
DM90 HAS DOCTOR SAID WHAT MAY HAVE CAUSED FALLS
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH89
Has a doctor said what might be causing the falls?
.................................................................................
8 1. Yes
36 5. No
97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
171 Blank. Inap
==========================================================================================
DM91 CAUSE OF FALLING
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH90
What did the doctor say was the cause?
.................................................................................
1. Arthritis
2. Strokes/TIAs
1 3. Parkinson's Disease
1 4. Hip Problems/Surgery
2 5. Knee Problems/Surgery
1 6. Back Pain/Problems
7. Poor Balance
8. Edema/Poor Circulation
9. Peripheral Neuropathy
10. Dementia
11. Generalized Weakness
12. Inner Ear Problems
1 13. Vision Problems
2 14. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
209 Blank. Inap
==========================================================================================
DM93 HAD A SEVERE HEAD INJURY SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH92
Since we last visited (him/her), has (NAME) had a blow to the head, a head
injury or head trauma that was severe enough to require medical attention, to
cause loss of consciousness or memory loss for a period of time?
.................................................................................
6 1. Yes
208 5. No
97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM94 NUMBER OF HEAD INJURIES
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH93
How many times has this happened during this time period (since the last visit)?
.................................................................................
6 1-5. Number
998. DK(Don't Know)
211 Blank. Inap
==========================================================================================
DM95 AGE OF LAST HEAD INJURY
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH94
Now I want you to think about (her/his) (last) head injury or trauma. How old
was (s/he) at that time?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
1 70-79. AGE
4 80-89. AGE
1 90-99. AGE
100-109. AGE
998. DK (Don't Know)
211 Blank. Inap
==========================================================================================
DM97 SEE DOCTOR OR GO TO HOSPITAL FOR HEAD INJ 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH96
Did (NAME) see a doctor or go to a hospital?
.................................................................................
1. Saw Doctor (Record)
6 2. Went Hospital (Record)
3. No Doctor or Hospital
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
211 Blank. Inap
==========================================================================================
DM99 DID SUBJECT LOSE CONSCIOUSNESS-HEAD INJ 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH98
Did (NAME) lose consciousness?
.................................................................................
1 1. Yes
5 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
211 Blank. Inap
==========================================================================================
DM100 HOW LONG UNCONSCIOUS - HEAD INJ 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH99
How long was (s/he) unconscious? (if DK, read choices)
.................................................................................
1. Less Than 5 Minutes
1 2. 5-29 Minutes
3. 30-59 Minutes
4. 1-24 Hours
5. More Than 1 Day
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM101 SUBJECT HAVE PERIOD OF AMNESIA-HEAD INJ 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH100
Sometimes, after a head injury, people experience amnesia or loss of memory. Did
(NAME) have a period of amnesia after the injury?
.................................................................................
1. Yes
6 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
211 Blank. Inap
==========================================================================================
DM102 HOW LONG WAS MEMORY LOSS-HEAD INJ 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH101
How long did (s/he) have this memory loss?
.................................................................................
1. 1-24 Hours
2. 2-6 Days
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM103 ANY SKULL PENETRATION TO BRAIN - HEAD INJ 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH102
At the time of this injury was there any penetration of the skull to the brain?
(e.g.,such as from shrapnel, a bullet wound, or other object)
.................................................................................
1. Yes
6 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
211 Blank. Inap
==========================================================================================
DM104 MEM PXS START BEF/IMM AFT/LAT AFT HEAD INJURY 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH103
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the head injury?
.................................................................................
4 1. Before
2. Immediately After
1 3. Later After
1 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
211 Blank. Inap
==========================================================================================
DM106 AGE AT TIME OF HEAD INJURY 2
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH105
Now, I want you to think about the previous head injury or head trauma. How
old was (NAME) at that time?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
1 80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM108 SEE DOCTOR OR GO TO HOSPITAL FOR HEAD INJ 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH107
Did (NAME) see a doctor or go to a hospital?
.................................................................................
1. Saw Doctor (Record)
1 2. Went Hospital (Record)
3. No Doctor or Hospital
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM110 DID SUBJECT LOSE CONSCIOUSNESS-HEAD INJ 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH109
Did (s/he) lose consciousness?
.................................................................................
1. Yes
1 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM111 HOW LONG UNCONSCIOUS-HEAD INJ 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH110
How long was (NAME) unconscious? (if DK, read choices)
.................................................................................
1. Less Than 5 Minutes
2. 5-29 Minutes
3. 30-59 Minutes
4. 1-24 Hours
5. More Than 1 Day
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM112 SUBJECT HAVE PERIOD OF AMNESIA-HEAD INJ 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH111
Sometimes, after a head injury, people experience amnesia or loss of memory.
Did (s/he) have a period of amnesia after the injury?
.................................................................................
1. Yes
1 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM113 HOW LONG WAS MEMORY LOSS-HEAD 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH112
How long did (NAME) have this memory loss?
.................................................................................
1. 1-24 Hours
2. 2-6 Days
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM114 ANY SKULL PENETRATION TO BRAIN - HEAD INJ 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH113
At the time of this injury was there any penetration of the skull to the brain?
(e.g., such as from shrapnel, a bullet wound, or other object)
.................................................................................
1. Yes
1 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM115 MEM PXS START BEF/IMM AFT/LAT AFT HEAD INJURY 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH114
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the head injury?
.................................................................................
1. Before
2. Immediately After
3. Later After
1 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM117 AGE AT TIME OF HEAD INJURY 3
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH116
Now, I want you to think about the previous head injury or head trauma. How old
was (NAME) at that time?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM119 SEE DOCTOR OR GO TO HOSPITAL FOR HEAD INJ 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH118
Did (NAME) see a doctor or go to a hospital?
.................................................................................
1. Saw Doctor (Record)
2. Went Hospital (Record)
3. No Doctor or Hospital
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM121 DID SUBJECT LOSE CONSCIOUSNESS-HEAD 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH120
Did (s/he) lose consciousness?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM122 HOW LONG UNCONSCIOUS - HEAD INJ 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH121
How long was (s/he) unconscious? (if DK, read choices)
.................................................................................
1. Less Than 5 Minutes
2. 5-29 Minutes
3. 30-59 Minutes
4. 1-24 Hours
5. More Than 1 Day
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM123 SUBJECT HAVE PERIOD OF AMNESIA-HEAD 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH122
Sometimes, after a head injury, people experience amnesia or loss of memory.
Did (NAME) have a period of amnesia after the injury?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM124 HOW LONG WAS THIS MEMORY LOSS-HEAD 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH123
How long did (NAME) have this memory loss?
.................................................................................
1. 1-24 Hours
2. 2-6 Days
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM125 ANY SKULL PENETRATION TO BRAIN - HEAD INJ 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH124
At the time of this injury was there any penetration of the skull to the brain?
(e.g such as from shrapnel, a bullet wound, or other object)
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM126 MEM PXS START BEF/IMM AFT/LAT AFT HEAD INJURY 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH125
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the head injury?
.................................................................................
1. Before
2. Immediately After
3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM128 AGE AT TIME OF HEAD INJURY 4
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH127
Now, I want you to think about the previous head injury or head trauma. How old
was (NAME) at that time?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM130 SEE DOCTOR OR GO TO HOSPITAL FOR HEAD INJ 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH129
Did (s/he) see a doctor or go to a hospital?
.................................................................................
1. Saw Doctor (Record)
2. Went Hospital (Record)
3. No Doctor or Hospital
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM132 DID SUBJECT LOSE CONSCIOUSNESS-HEAD INJ 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH131
Did (NAME) lose consciousness?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM133 HOW LONG WAS SUBJECT UNCONSCIOUS-HEAD INJ 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH132
How long was (s/he) unconscious? (if DK, read choices)
.................................................................................
1. Less Than 5 Minutes
2. 5-29 Minutes
3. 30-59 Minutes
4. 1-24 Hours
5. More Than 1 Day
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM134 SUBJECT HAVE PERIOD OF AMNESIA-HEAD INJ 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH133
Sometimes, after a head injury, people experience amnesia or loss of memory. Did
(NAME) have a period of amnesia after the injury?
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM135 HOW LONG WAS THIS MEMORY LOSS-HEAD INJ 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH134
How long did (s/he) have this memory loss?
.................................................................................
1. 1-24 Hours
2. 2-6 Days
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM136 ANY SKULL PENETRATION TO BRAIN - HEAD INJ 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH135
At the time of this injury was there any penetration of the skull to the brain?
(e.g., such as from shrapnel, a bullet wound, or other object)
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM137 MEM PXS START BEF/IMM AFT/LAT AFT HEAD INJURY 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH136
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the head injury?
.................................................................................
1. Before
2. Immediately After
3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM139 HAD OTHER BRAIN INJURY SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH138
Since we last visited (him/her), has (NAME) had any other brain injury such as a
blast injury or hematoma (bleed or blood clot on the brain)?
.................................................................................
1. Yes
215 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM140 TYPE OF OTHER BRAIN INJURY
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH139
What type of injury?
.................................................................................
1. Blast Injury
2. Hematoma
3. Aneurysm
4. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM141 AGE AT TIME OF OTHER BRAIN INJURY
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH140
How old was (s/he) when this happened?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM143 MEM PXS START BEF/IMM AFT/LAT AFT BRAIN INJURY
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH142
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the brain injury?
.................................................................................
1. Before
2. Immediately After
3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM144 HAD EPILEPTIC SEIZURES OR FITS SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH143
Since we last visited (him/her), has (s/he) had epileptic seizures or fits or
has (s/he) received treatment for epileptic seizures or fits?
.................................................................................
3 1. Yes
212 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM145 AGE AT TIME OF FIRST SEIZURE
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH144
How old was (NAME) when (s/he) had (her/his) first seizure?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
1 60-69. AGE
70-79. AGE
2 80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
214 Blank. Inap
==========================================================================================
DM146 DID SUBJECT TAKE MEDICINE FOR SEIZURE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH145
Did (s/he) take medication for this? [or if informant has already said
respondent is being treated, state in confirmatory manner, "you said (s/he) is
being treated for this now, right?"]
.................................................................................
2 1. Yes
1 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
214 Blank. Inap
==========================================================================================
DM147NUM DURATION (NUMBER) FOR SEIZURE MEDS
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH146NUM
How long was (NAME) on the seizure medication? (Number Duration)
.................................................................................
1 1-5. Number
6-10. Number
1 11-95. Number
97. Not Asked/Not Assessed
98. DK (Don't Know)
215 Blank. Inap
==========================================================================================
DM147DUR DURATION (TIMEFRAME) FOR SEIZURE MEDS
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH146DUR
How long was (NAME) on the seizure medication? (Timeframe Duration)
.................................................................................
1. Months
2 2. Years
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM148 MEM PXS START BEF/IMM AFT/LAT AFT SEIZURE/FITS
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH147
To the best of your recollection, did the memory problems start before,
immediately after or sometime later after the seizures or fits?
.................................................................................
2 1. Before
2. Immediately After
3. Later After
96. Skipped/Not Applicable
1 97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
214 Blank. Inap
==========================================================================================
DM150 TOLD BY MED PERSONNEL HAD HBP/HTN SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH149
Since we last visited (him/her), has (NAME) been told by medical personnel that
(s/he) had high blood pressure or hypertension or has (s/he) been treated for
high blood pressure or hypertension?
.................................................................................
148 1. Yes
64 5. No
97. Not Asked/Not Assessed
4 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM151 AGE WHEN TOLD HAD HBP OR HTN
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH150
How old was (NAME) when medical personnel first told (her/him) that (s/he) had
high blood pressure?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
3 30-39. AGE
3 40-49. AGE
7 50-59. AGE
24 60-69. AGE
37 70-79. AGE
18 80-89. AGE
1 90-99. AGE
100-109. AGE
55 998. DK (Don't Know)
69 Blank. Inap
==========================================================================================
DM152 DID DOCTOR PRESCRIBE MEDICINE FOR HBP
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH151
Did a doctor prescribe medication for the high blood pressure? [or if informant
has already said respondent is being treated state in confirmatory manner, "you
said (s/he) is being treated for this now, right?"]
.................................................................................
146 1. Yes
1 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
69 Blank. Inap
==========================================================================================
DM153 IS SUBJECT CURRENTLY TREATED FOR HBP
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH152
Is (NAME) currently being treated for high blood pressure? [If confirmed current
treatment in # 151, just code YES here, don't ask again]
.................................................................................
142 1. Yes
4 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
71 Blank. Inap
==========================================================================================
DM154 DID DR DX HIGH CHOLESTEROL/TRIGLYCERIDES
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH153
Since we last visited (him/her), has [NAME] been told by medical personnel that
(s/he) has high cholesterol or high triglycerides or has (s/he) been treated
for high cholesterol or high triglycerides?
.................................................................................
100 1. Yes
101 5. No
97. Not Asked/Not Assessed
15 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM155 AGE TOLD HIGH CHOLESTEROL/TRIGLYCERIDES
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH154
How old was (s/he) when first told (s/he) had has high cholesterol or high
triglycerides?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
1 30-39. AGE
1 40-49. AGE
3 50-59. AGE
14 60-69. AGE
26 70-79. AGE
10 80-89. AGE
90-99. AGE
100-109. AGE
45 998. DK (Don't Know)
117 Blank. Inap
==========================================================================================
DM156 HAD HRT ATTACK/MI/ COR THROMBOSIS SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH155
Since we last visited (him/her), has (NAME) had a heart attack, a myocardial
infarction, or a coronary thrombosis?
.................................................................................
3 1. Yes
212 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM157 HOW MANY HEART ATTACKS HAS SUBJECT HAD
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH156
How many heart attacks has (s/he) had since our last visit?
.................................................................................
3 1-5. Number
998. DK (Don't Know)
214 Blank. Inap
==========================================================================================
DM158 AGE AT TIME OF FIRST HEART ATTACK
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH157
How old was (NAME) when (s/he) had (her/his) (first) heart attack (coronary) in
this time period (since our last visit)?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
1 70-79. AGE
1 80-89. AGE
1 90-99. AGE
100-109. AGE
998. DK (Don't Know)
214 Blank. Inap
==========================================================================================
DM159 IF MULTIPLE, AGE AT LAST HEART ATTACK
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH158
If more than one, how old was (NAME) when (s/he) had (her/his) last heart attack
(coronary) in this time period (since our last visit)?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
1 80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM160 MEM PXS START BEF/IMM AFT/LAT AFT HEART ATTACKS
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH159
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the heart attack(s)?
.................................................................................
2 1. Before
2. Immediately After
3. Later After
1 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
214 Blank. Inap
==========================================================================================
DM162 HAD ANY OTHER HEART PROBLEMS SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH161
Since we last visited (him/her), has (NAME) had other heart problems?
.................................................................................
65 1. Yes
150 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM163A HAD ANGINA SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162A
What type of problems: ANGINA
.................................................................................
9 1. Yes
56 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
152 Blank. Inap
==========================================================================================
DM163B HAD ATRIAL FIBRILLATION SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162B
What type of problems: ATRIAL FIBRILLATION
.................................................................................
9 1. Yes
56 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
152 Blank. Inap
==========================================================================================
DM163C HAD VENTRICULAR FIBRILLATION SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162C
What type of problems: VENTRICULAR FIBRILLATION
.................................................................................
1. Yes
65 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
152 Blank. Inap
==========================================================================================
DM163D HAD ARRHYTHMIA, UNCLEAR ETIOLOGY SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162D
What type of problems: ARRHYTHMIA DUE TO UNCLEAR ETIOLOGY
.................................................................................
15 1. Yes
50 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
152 Blank. Inap
==========================================================================================
DM163E HAD CABG SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162E
What type of problems: CABG
.................................................................................
2 1. Yes
63 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
152 Blank. Inap
==========================================================================================
DM163F HAD ANGIOPLASTY OR STENT SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162F
What type of problems: ANGIOPLASTY OR STENT PLACEMENT
.................................................................................
4 1. Yes
61 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
152 Blank. Inap
==========================================================================================
DM163G HAD CONGESTIVE HEART FAILURE SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162G
What type of problems: CHF
.................................................................................
13 1. Yes
52 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
152 Blank. Inap
==========================================================================================
DM163H HAD BRADYCARDIA SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162H
What type of problems: BRADYCARDIA
.................................................................................
4 1. Yes
61 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
152 Blank. Inap
==========================================================================================
DM163I HAD TACHYCARDIA SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162I
What type of problems: TACHYCARDIA
.................................................................................
1 1. Yes
64 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
152 Blank. Inap
==========================================================================================
DM163J HAD PACEMAKER/DEFIBRILLATOR SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162JA
What type of problems: PACEMAKER
.................................................................................
9 1. Yes
56 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
152 Blank. Inap
==========================================================================================
DM163W OTHER TYPE OF HEART PROBLEM 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162J
What type of problems: Other (specify)
.................................................................................
23 1. Yes
41 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
152 Blank. Inap
==========================================================================================
DM163X OTHER TYPE OF HEART PROBLEM 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162K
What type of problems: Other (specify)
.................................................................................
3 1. Yes
18 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
196 Blank. Inap
==========================================================================================
DM163Y OTHER TYPE OF HEART PROBLEM 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162L
What type of problems: Other (specify)
.................................................................................
1. Yes
3 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
214 Blank. Inap
==========================================================================================
DM164A AGE DX WITH ANGINA
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162AAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had ANGINA
[or when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
1 50-59. AGE
1 60-69. AGE
5 70-79. AGE
1 80-89. AGE
90-99. AGE
100-109. AGE
1 998. DK (Don't Know)
208 Blank. Inap
==========================================================================================
DM164B AGE HAD ATRIAL FIBRILLATION
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162BAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had ATRIAL
FIBRILLATION [or when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
1 20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
1 60-69. AGE
2 70-79. AGE
4 80-89. AGE
90-99. AGE
100-109. AGE
1 998. DK (Don't Know)
208 Blank. Inap
==========================================================================================
DM164C AGE HAD VENTRICULAR FIBRILLATION
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162CAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had
VENTRICULAR FIBRILLATION [or when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM164D AGE HAD ARRHYTHMIA
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162DAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had
ARRHYTHMIA due to unclear etiology [or when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
1 50-59. AGE
1 60-69. AGE
6 70-79. AGE
1 80-89. AGE
90-99. AGE
100-109. AGE
6 998. DK (Don't Know)
202 Blank. Inap
==========================================================================================
DM164E AGE HAD CABG
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162EAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had CABG [or
when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
1 70-79. AGE
1 80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
215 Blank. Inap
==========================================================================================
DM164F AGE OF ANGIOPLASTY OR STENT PLACEMENT
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162FAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had
ANGIOPLASTY OR STENT PLACEMENT [or when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
3 70-79. AGE
1 80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
213 Blank. Inap
==========================================================================================
DM164G AGE HAD CONGESTIVE HEART FAILURE
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162GAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had CHF [or
when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
2 60-69. AGE
3 70-79. AGE
3 80-89. AGE
4 90-99. AGE
100-109. AGE
1 998. DK (Don't Know)
204 Blank. Inap
==========================================================================================
DM164H AGE HAD BRADYCARDIA
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162HAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had
BRADYCARDIA [or when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
2 80-89. AGE
1 90-99. AGE
100-109. AGE
1 998. DK (Don't Know)
213 Blank. Inap
==========================================================================================
DM164I AGE HAD TACHYCARDIA
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162IAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had
TACHYCARDIA [or when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
1 70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM164J AGE HAD PACEMAKER
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162JAGEA
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had a
PACEMAKER? [or when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
4 70-79. AGE
4 80-89. AGE
1 90-99. AGE
100-109. AGE
998. DK (Don't Know)
208 Blank. Inap
==========================================================================================
DM164W AGE FOR OTHER 1
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162JAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had
(SPECIFIED heart condition) [or when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
1 40-49. AGE
1 50-59. AGE
4 60-69. AGE
8 70-79. AGE
4 80-89. AGE
90-99. AGE
100-109. AGE
5 998. DK (Don't Know)
194 Blank. Inap
==========================================================================================
DM164X AGE FOR OTHER 2
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162KAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had
(SPECIFIED heart condition) [or when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
2 70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
1 998. DK (Don't Know)
214 Blank. Inap
==========================================================================================
DM164Y AGE FOR OTHER 3
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH162LAGE
[If endorses above], how old was (s/he) when (s/he) was told (s/he) had
(SPECIFIED heart condition) [or when the ___________ was done]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM165A MEM PX BEF/IMM AFT/LAT AFT ANGINA
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162ABEF
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [ANGINA]?
.................................................................................
4 1. Before
2. Immediately After
4 3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
208 Blank. Inap
==========================================================================================
DM165B MEM PX BEF/IMM AFT/LAT AFT ATRIAL FIB
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162BBEF
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [ATRIAL FIBRILLATION]?
.................................................................................
1 1. Before
2. Immediately After
4 3. Later After
1 96. Skipped/Not Applicable
1 97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
208 Blank. Inap
==========================================================================================
DM165C MEM PX BEF/IMM AFT/LAT AFT VENT FIB
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162CBEF
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [VENTRICULAR FIBRILLATION]?
.................................................................................
1. Before
2. Immediately After
3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM165D MEM PX BEF/IMM AFT/LAT AFT ARRHYTHMIA
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162DBEF
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [ARRHYTHMIA DUE TO UNCLEAR
ETIOLOGY]?
.................................................................................
3 1. Before
2. Immediately After
6 3. Later After
3 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
3 98. DK (Don't Know)
99. RF (Refused)
202 Blank. Inap
==========================================================================================
DM165E MEM PX BEF/IMM AFT/LAT AFT CABG
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162EBEF
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [CABG]?
.................................................................................
1 1. Before
1 2. Immediately After
3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM165F MEM PX BEF/IMM AFT/LAT AFT ANGIOPLASTY
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162FBEF
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [ANGIOPLASTY OR STENT PLACEMENT?
.................................................................................
2 1. Before
2. Immediately After
3. Later After
1 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
213 Blank. Inap
==========================================================================================
DM165G MEM PX BEF/IMM AFT/LAT AFT CHF
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162GBEF
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [CHF]?
.................................................................................
7 1. Before
2. Immediately After
4 3. Later After
1 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
204 Blank. Inap
==========================================================================================
DM165H MEM PX BEF/IMM AFT/LAT AFT BRADYCARDIA
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162HBEF
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [BRADYCARDIA]?
.................................................................................
2 1. Before
2. Immediately After
2 3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
213 Blank. Inap
==========================================================================================
DM165I MEM PX BEF/IMM AFT/LAT AFT TACHYCARDIA
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162IBEF
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [TACHYCARDIA]?
.................................................................................
1. Before
2. Immediately After
1 3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM165J MEM PX BEF/IMM AFT/LAT AFT PACEMAKER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162JBEFA
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [PACEMAKER]?
.................................................................................
6 1. Before
2. Immediately After
1 3. Later After
1 96. Skipped/Not Applicable
1 97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
208 Blank. Inap
==========================================================================================
DM165W MEM PX BEF/IMM AFT/LAT AFT OTHER 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162JBEF
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [SPECIFIED heart condition]?
.................................................................................
6 1. Before
2. Immediately After
12 3. Later After
3 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
194 Blank. Inap
==========================================================================================
DM165X MEM PX BEF/IMM AFT/LAT AFT OTHER 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162KBEF
To the best of your recollection, did the memory problems start before,
immediately after, or some time later after [SPECIFIED heart condition]?
.................................................................................
2 1. Before
2. Immediately After
1 3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
214 Blank. Inap
==========================================================================================
DM165Y MEM PX BEF/IMM AFT/LAT AFT OTHER 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH162LBEF
To the best of your recollection, did the memory problems start before,
immediately after or some time later after [SPECIFIED heart condition]?
.................................................................................
1. Before
2. Immediately After
3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM172 HAD CAROTID ENDARTERECTOMY SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH171
Since we last visited (him/her), has (NAME) had a carotid endarterectomy or
surgery on the arteries in her/his neck?
.................................................................................
1 1. Yes
214 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM173 AGE AT FIRST CAROTID ENDARTERECTOMY
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH172
If yes, how old was (NAME) when (s/he)/she first had carotid endarterectomy?
(since our last visit)
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
1 80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM174 BEEN TOLD BY DOCTOR HAD DIABETES SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH173
Since we last visited (him/her), has (s/he) been told by a doctor that (s/he)
has diabetes or has (s/he) been treated for diabetes?
.................................................................................
38 1. Yes
175 5. No
97. Not Asked/Not Assessed
3 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM175 AGE WHEN FIRST LEARNED HAD DIABETES
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH174
How old was (NAME) when (s/he) first learned (s/he) had diabetes?
.................................................................................
1-9. AGE
10-19. AGE
1 20-29. AGE
1 30-39. AGE
1 40-49. AGE
2 50-59. AGE
10 60-69. AGE
11 70-79. AGE
7 80-89. AGE
90-99. AGE
100-109. AGE
5 998. DK (Don't Know)
179 Blank. Inap
==========================================================================================
DM176 DID DR PRESCRIBE TREATMENT FOR DIABETES
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH175
Did a doctor prescribe a treatment for the diabetes? [or if Informant has
already said Respondent is being treated, state in confirmatory manner, "you
said (s/he) is being treated for this now, right?"] [Confirm type of current
treatment]
.................................................................................
7 1. Yes, Diet
24 2. Yes, Pills
7 3. Yes, Insulin
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM177 DOES SUBJECT STILL HAVE DIABETES NOW
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH176
Does (s/he) still have diabetes now? [If confirmed current treatment, just code
YES, don't ask again]
.................................................................................
37 1. Yes
1 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM178 MEM PXS START BEF/IMM AFT/LAT AFT TOLD DIABETES
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH177
To the best of your recollection, did the memory problems start before,
immediately after or some time later after (s/he) was told (s/he) had diabetes?
.................................................................................
6 1. Before
1 2. Immediately After
23 3. Later After
7 96. Skipped/Not Applicable
1 97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM180 TOLD BY DOCTOR HAD THYROID DISEASE SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH179
Since we last visited (him/her), has a doctor told [NAME] that (s/he) has
thyroid disease or has (s/he) been treated for thyroid disease?
.................................................................................
36 1. Yes
173 5. No
97. Not Asked/Not Assessed
7 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM181 AGE WHEN DOCTOR TOLD HAD THYROID DISEASE
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH180
How old was [NAME] when the doctor first told (her/him) that (s/he) had thyroid
disease?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
1 30-39. AGE
1 40-49. AGE
4 50-59. AGE
5 60-69. AGE
7 70-79. AGE
6 80-89. AGE
90-99. AGE
100-109. AGE
12 998. DK (Don't Know)
181 Blank. Inap
==========================================================================================
DM182 MEM PXS START BEF/IMM AFT/LAT AFT TOLD THYROID
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH181
To the best of your recollection, did the memory problems start before,
immediately after or some time later after (s/he) was told (s/he) had thyroid
disease?
.................................................................................
2 1. Before
2. Immediately After
22 3. Later After
8 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
4 98. DK (Don't Know)
99. RF (Refused)
181 Blank. Inap
==========================================================================================
DM183 HAD CHRONIC RESPIRATORY PXS SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH182
Since we last visited (him/her), has [Name] had chronic respiratory problems?
.................................................................................
38 1. Yes
176 5. No
97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM184A HAD ASTHMA LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH183A
What type of problems: ASTHMA
.................................................................................
12 1. Yes
26 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM184B HAD CHRONIC BRONCHITIS LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH183B
What type of problems: CHRONIC BRONCHITIS
.................................................................................
2 1. Yes
36 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM184C HAD COPD LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH183C
What type of problems: COPD
.................................................................................
12 1. Yes
26 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM184D HAD EMPHYSEMA LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH183D
What type of problems: EMPHYSEMA
.................................................................................
8 1. Yes
30 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM184E HAD COUGH, NON SPECIFIC LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH183E
What type of problems: COUGH (NO SPECIFIC DIAGNOSIS)
.................................................................................
3 1. Yes
35 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM184F HAD WHEEZING, NON SPECIFIC LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH183F
What type of problems: WHEEZING (NO SPECIFIC DIAGNOSIS)
.................................................................................
1. Yes
38 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM184G HAD DYSPNEA, NON SPECIFIC LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH183G
What type of problems: DYSPNEA (NO SPECIFIC DIAGNOSIS)
.................................................................................
2 1. Yes
36 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM184H HAD OTHER RESP PX LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH183H
What type of problems: Other (specify)
.................................................................................
4 1. Yes
34 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM185 USING OXYGEN FOR RESPIRATORY PROBLEM
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH184
Is (s/he) on oxygen for her/his respiratory problems?
.................................................................................
9 1. Yes
29 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
179 Blank. Inap
==========================================================================================
DM185HR DURATION OF OXYGEN FOR RESPIRATORY PX
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH184HRS
If yes, on oxygen for: (Number Duration)
.................................................................................
1 1-5. Number
6-10. Number
4 11-95. Number
98. Don't know
212 Blank. Inap
==========================================================================================
DM185PM DURATION OF OXYGEN (AM/PM)
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH184PM
If yes, on oxygen for: (Timeframe Duration)
.................................................................................
5 1. Hours/Day
4 2. Night Only
208 Blank. Inap
==========================================================================================
DM186 AGE WHEN STARTED OXYGEN TREATMENT
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH185
How old was (s/he) when (s/he) starting taking this treatment?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
3 70-79. AGE
4 80-89. AGE
2 90-99. AGE
100-109. AGE
998. DK (Don't Know)
208 Blank. Inap
==========================================================================================
DM187 TOLD BY DOCTOR HAD SLEEP APNEA SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH186
Since we last visited (him/her), has a doctor told [NAME] that (s/he) has sleep
apnea or has (s/he) been treated for sleep apnea?
.................................................................................
5 1. Yes
206 5. No
97. Not Asked/Not Assessed
5 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM188 AGE WHEN DIAGNOSED WITH SLEEP APNEA
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH187
How old was (s/he) when (s/he) was diagnosed with sleep apnea?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
3 60-69. AGE
2 70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
212 Blank. Inap
==========================================================================================
DM189 DIFFICULTY STAYING AWAKE DURING DAYTIME
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH188
Does (s/he) have a lot of difficulty staying awake during the daytime?
.................................................................................
52 1. Yes
162 5. No
97. Not asked/not assessed
2 98. DK
99. RF
1 Blank. Inap
==========================================================================================
DM190 BEEN DIAGNOSED WITH ANY CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH189
Since we last visited (him/her), has (s/he) been diagnosed with any type of
cancer or treated for any type of cancer?
.................................................................................
22 1. Yes
190 5. No
97. Not asked/not assessed
3 98. DK
99. RF
2 Blank. Inap
==========================================================================================
DM191A DIAGNOSED WITH PROSTATE CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH190A
What type: PROSTATE CANCER
.................................................................................
8 1. Yes
14 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM191B DIAGNOSED WITH LUNG CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH190B
What type: LUNG CANCER
.................................................................................
1. Yes
22 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM191C DIAGNOSED WITH BREAST CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH190C
What type: BREAST CANCER
.................................................................................
1. Yes
22 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM191D DIAGNOSED WITH COLON CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH190D
What type: COLON CANCER
.................................................................................
2 1. Yes
20 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM191E DIAGNOSED WITH OVARIAN CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH190E
What type: OVARIAN CANCER
.................................................................................
1. Yes
22 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM191F DIAGNOSED WITH BLADDER CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH190F
What type: BLADDER CANCER
.................................................................................
1. Yes
22 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM191G DIAGNOSED WITH LYMPH CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH190G
What type: LYMPH CANCER
.................................................................................
1. Yes
22 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM191H DIAGNOSED WITH UTERINE CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH190H
What type: UTERINE CANCER
.................................................................................
1. Yes
22 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM191J DIAGNOSED WITH SKIN CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH190I
What type: SKIN CANCER
.................................................................................
11 1. Yes
11 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM191K DIAGNOSED WITH BRAIN CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH190J
What type: BRAIN CANCER
.................................................................................
1. Yes
22 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM191L DIAGNOSED WITH OTHER TYPE OF CANCER SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH190K
What type: OTHER (specify, other type of cancer diagnosis)
.................................................................................
4 1. Yes
18 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM192A AGE WHEN TOLD HAD PROSTATE CANCER
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH191AAGE
(If endorsed) How old was (s/he) when (s/he) was told (s/he) had [PROSTATE
CANCER]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
3 70-79. AGE
5 80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
209 Blank. Inap
==========================================================================================
DM192B AGE WHEN TOLD HAD LUNG CANCER
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH191BAGE
(If endorsed) How old was (s/he) when (s/he) was told (s/he) had [LUNG CANCER]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM192C AGE WHEN TOLD HAD BREAST CANCER
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH191CAGE
(If endorsed) How old was (s/he) when (s/he) was told (s/he) had [BREAST
CANCER]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM192D AGE WHEN TOLD HAD COLON CANCER
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH191DAGE
(If endorsed) How old was (s/he) when (s/he) was told (s/he) had [COLON CANCER]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
1 70-79. AGE
1 80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
215 Blank. Inap
==========================================================================================
DM192E AGE WHEN TOLD HAD OVARIAN CANCER
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH191EAGE
(If endorsed) How old was (s/he) when (s/he) was told (s/he) had [OVARIAN
CANCER]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM192F AGE WHEN TOLD HAD BLADDER CANCER
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH191FAGE
(If endorsed) How old was (s/he) when (s/he) was told (s/he) had [BLADDER
CANCER]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM192G AGE WHEN TOLD HAD LYMPH CANCER
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH191GAGE
(If endorsed) How old was (s/he) when (s/he) was told (s/he) had [LYMPH CANCER]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM192H AGE WHEN TOLD HAD UTERINE CANCER
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH191HAGE
(If endorsed) How old was (s/he) when (s/he) was told (s/he) had [UTERINE
CANCER]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM192J AGE WHEN TOLD HAD SKIN CANCER
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH191IAGE
(If endorsed) How old was (s/he) when (s/he) was told (s/he) had [SKIN CANCER]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
3 70-79. AGE
6 80-89. AGE
1 90-99. AGE
100-109. AGE
1 998. DK (Don't Know)
206 Blank. Inap
==========================================================================================
DM192K AGE WHEN TOLD HAD BRAIN CANCER
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH191JAGE
(If endorsed) How old was (s/he) when (s/he) was told (s/he) had [BRAIN CANCER]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM192L AGE WHEN TOLD HAD OTHER TYPE OF CANCER 1
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH191KAGE
(If endorsed) How old was (s/he) when (s/he) was told (s/he) had this [OTHER
CANCER]?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
1 70-79. AGE
2 80-89. AGE
1 90-99. AGE
100-109. AGE
998. DK (Don't Know)
213 Blank. Inap
==========================================================================================
DM193A1 FIRST TREATMENT FOR PROSTATE CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191ATX
Treatment 1: What type of treatment did (s/he) have for prostate cancer?
.................................................................................
1 1. Radiation
2. Chemotherapy
3 3. Surgery
3 4. Other Medication
5. None
1 6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
209 Blank. Inap
==========================================================================================
DM193A2 SECOND TREATMENT FOR PROSTATE CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191ATX2
Treatment 2: What type of treatment did (s/he) have for prostate cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
1 4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM193A3 THIRD TREATMENT FOR PROSTATE CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191ATX3
Treatment 3: What type of treatment did (s/he) have for prostate cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193B1 FIRST TREATMENT FOR LUNG CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191BTX
Treatment 1: What type of treatment did (s/he) have for lung cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193B2 SECOND TREATMENT FOR LUNG CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191BTX2
Treatment 2: What type of treatment did (s/he) have for lung cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193B3 THIRD TREATMENT FOR LUNG CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191BTX3
Treatment 3: What type of treatment did (s/he) have for lung cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193C1 FIRST TREATMENT FOR BREAST CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191CTX
Treatment 1: What type of treatment did (s/he) have for breast cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193C2 SECOND TREATMENT FOR BREAST CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191CTX2
Treatment 2: What type of treatment did (s/he) have for breast cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193C3 THIRD TREATMENT FOR BREAST CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191CTX3
Treatment 3: What type of treatment did (s/he) have for breast cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193D1 FIRST TREATMENT FOR COLON CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191DTX
Treatment 1: What type of treatment did (s/he) have for colon cancer?
.................................................................................
1 1. Radiation
2. Chemotherapy
1 3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
215 Blank. Inap
==========================================================================================
DM193D2 SECOND TREATMENT FOR COLON CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191DTX2
Treatment 2: What type of treatment did (s/he) have for colon cancer?
.................................................................................
1. Radiation
2. Chemotherapy
1 3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM193D3 THIRD TREATMENT FOR COLON CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191DTX3
Treatment 3: What type of treatment did (s/he) have for colon cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193E1 FIRST TREATMENT FOR OVARIAN CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191ETX
Treatment 1: What type of treatment did (s/he) have for ovarian cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193E2 SECOND TREATMENT FOR OVARIAN CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191ETX2
Treatment 2: What type of treatment did (s/he) have for ovarian cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193E3 THIRD TREATMENT FOR OVARIAN CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191ETX3
Treatment 3: What type of treatment did (s/he) have for ovarian cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193F1 FIRST TREATMENT FOR BLADDER CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191FTX
Treatment 1: What type of treatment did (s/he) have for bladder cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193F2 SECOND TREATMENT FOR BLADDER CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191FTX2
Treatment 2: What type of treatment did (s/he) have for bladder cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193F3 THIRD TREATMENT FOR BLADDER CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191FTX3
Treatment 3: What type of treatment did (s/he) have for bladder cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193G1 FIRST TREATMENT FOR LYMPH CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191GTX
Treatment 1: What type of treatment did (s/he) have for lymph cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193G2 SECOND TREATMENT FOR LYMPH CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191GTX2
Treatment 2: What type of treatment did (s/he) have for lymph cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193G3 THIRD TREATMENT FOR LYMPH CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191GTX3
Treatment 3: What type of treatment did (s/he) have for lymph cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193H1 FIRST TREATMENT FOR UTERINE CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191HTX
Treatment 1: What type of treatment did (s/he) have for uterine cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193H2 SECOND TREATMENT FOR UTERINE CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191HTX2
Treatment 2: What type of treatment did (s/he) have for uterine cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193H3 THIRD TREATMENT FOR UTERINE CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191HTX3
Treatment 3: What type of treatment did (s/he) have for uterine cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193J1 FIRST TREATMENT FOR SKIN CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191ITX
Treatment 1: What type of treatment did (s/he) have for skin cancer?
.................................................................................
1 1. Radiation
2. Chemotherapy
8 3. Surgery
4. Other Medication
1 5. None
6. Other (Specify)
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
206 Blank. Inap
==========================================================================================
DM193J2 SECOND TREATMENT FOR SKIN CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191ITX2
Treatment 2: What type of treatment did (s/he) have for skin cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193J3 THIRD TREATMENT FOR SKIN CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191ITX3
Treatment 3: What type of treatment did (s/he) have for skin cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193K1 FIRST TREATMENT FOR BRAIN CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191JTX
Treatment 1: What type of treatment did (s/he) have for brain cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193K2 SECOND TREATMENT FOR BRAIN CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191JTX2
Treatment 2: What type of treatment did (s/he) have for brain cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193K3 THIRD TREATMENT FOR BRAIN CANCER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191JTX3
Treatment 3: What type of treatment did (s/he) have for brain cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193L1 FIRST TREATMENT FOR OTHER CANCER 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191KTX
Treatment 1: What type of treatment did (s/he) have for the (other) cancer?
.................................................................................
1 1. Radiation
2. Chemotherapy
3. Surgery
1 4. Other Medication
2 5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
213 Blank. Inap
==========================================================================================
DM193L2 SECOND TREATMENT FOR OTHER CANCER 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191KTX2
Treatment 2: What type of treatment did (s/he) have for the (other) cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM193L3 THIRD TREATMENT FOR OTHER CANCER 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH191KTX3
Treatment 3: What type of treatment did (s/he) have for the (other) cancer?
.................................................................................
1. Radiation
2. Chemotherapy
3. Surgery
4. Other Medication
5. None
6. Other (Specify)
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM205 DRUNK ALCOHOL SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH195
Since we last visited (him/her), has (NAME) drunk alcohol?
.................................................................................
86 1. Yes
129 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
2 Blank. Inap
==========================================================================================
DM206 HAD PX DRINKING MORE THAN SHOULD SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH196
During this time, has (NAME) had a problem drinking more alcohol than (s/he)
should?
.................................................................................
9 1. Yes
76 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
131 Blank. Inap
==========================================================================================
DM207 AGE STARTED HAVING PROBLEM WITH DRINKING
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH197
How old was (s/he) when (s/he) started having a problem drinking more alcohol
than (s/he) should?
.................................................................................
1 1-9. AGE
10-19. AGE
1 20-29. AGE
30-39. AGE
1 40-49. AGE
50-59. AGE
2 60-69. AGE
70-79. AGE
2 80-89. AGE
90-99. AGE
100-109. AGE
2 998. DK (Don't Know)
208 Blank. Inap
==========================================================================================
DM208 STILL DRINKING MORE ALCOHOL THAN SHOULD
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH198
Is (s/he) still drinking more alcohol then (s/he) should?
.................................................................................
8 1. Yes
5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
208 Blank. Inap
==========================================================================================
DM209 AGE STOPPED DRINKING MORE THAN SHOULD
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH199
If not, how old was (s/he) when (s/he) stopped drinking more alcohol than (s/he)
should?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM210NUM TYPICAL NUMBER OF DRINKS
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH200NUM
During the time when (s/he) was drinking more alcohol than (s/he) should, how
much did (s/he) typically drink? (Number of Drinks)
.................................................................................
4 1-5. Number
6-10. Number
1 11-95. Number
997. Not Asked/Not Assessed
4 998. DK (Don't know)
208 Blank. Inap
==========================================================================================
DM210DUR TIME PERIOD FOR TYPICAL NUMBER OF DRINKS
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH200DUR
During the time between the last visit and now, when (s/he) was drinking more
alcohol than (s/he) should, how much did (s/he) typically drink? (Timeframe)
.................................................................................
3 1. Day
3 2. Week
3. Month
97. Not Asked/Not Assessed
3 98. DK (Don't Know)
99. RF (Refused)
208 Blank. Inap
==========================================================================================
DM211 TREATED FOR DRINKING SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH201
During this time, has (s/he) ever received treatment for drinking more alcohol
than (s/he) should?
.................................................................................
1. Yes
9 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
208 Blank. Inap
==========================================================================================
DM212 CHARGED WITH DUI/DWI SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH202
During this time, has (s/he) ever been charged with driving while under the
influence of alcohol?
.................................................................................
1. Yes
9 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
208 Blank. Inap
==========================================================================================
DM214 HAVE FAMILY PX BECAUSE OF DRINKING SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH203
During this time between the last visit and now, when (s/he) was drinking more
than (s/he) should, did her/his drinking cause (her/him) to have problems with
family members or friends?
.................................................................................
4 1. Yes
5 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
208 Blank. Inap
==========================================================================================
DM216 MEM PX START BEFORE, IMM AFTER, LAT AFTER DRINKING
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH205
To the best of your recollection, did the memory problems start before,
immediately after or some time later after (her/his) drinking more alcohol than
(s/he) should (CLARIFY THAT AFTER MEANS 'AFTER STOPPED DRINKING MORE THAN S/HE
SHOULD')?
.................................................................................
1 1. Before
2. Immediately After
1 3. Later After
4 96. Skipped/Not Applicable
1 97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
208 Blank. Inap
==========================================================================================
DM218 MEM PX CHANGE WHEN STOPPED DRINKING
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH207
Did her/his memory improve, stay the same or get worse after (s/he) stopped
using more alcohol then (s/he) should?
.................................................................................
1. Improve
2. Stay Same
3. Get Worse
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM220 SMOKED CIGARETTES OR CIGARS SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH209
Since we last visited (him/her), has (s/he) smoked cigarettes or cigars?
.................................................................................
13 1. Yes
202 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM221 AGE STARTED SMOKING CIGARETTES/CIGARS
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH210
How old was (s/he) when (s/he) started smoking cigarettes or cigars?
.................................................................................
8 1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
5 998. DK (Don't Know)
204 Blank. Inap
==========================================================================================
DM222 SUBJECT STILL SMOKING CIGARETTES/CIGARS
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH211
Is (s/he) still smoking cigarettes or cigars?
.................................................................................
12 1. Yes
1 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
204 Blank. Inap
==========================================================================================
DM223 AGE STOPPED SMOKING CIGARS/CIGARETTES
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH212
If no, when did (s/he) stop smoking cigarettes or cigars?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
1 80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM224 HAD 2 WEEK PERIOD OF DEPRESSION SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH213
Now I am going to ask you a few questions about (Name's) mood:
Since we last visited (him/her), has (NAME) ever had a period of two weeks or
more when, nearly every day, (s/he) felt sad, blue or depressed?
.................................................................................
19 1. Yes
196 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM226 HAD 2 WEEK PERIOD OF LOST INTEREST SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH215
Since we last visited (him/her), has (NAME) ever had a period of two weeks or
more when, nearly every day, (s/he) lost all interest and pleasure in things
that (s/he) usually cared about or enjoyed?
.................................................................................
10 1. Yes
205 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM228 HAD 2 WEEK PERIOD FELT IRRITABLE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH217
Since we last visited (him/her), has (NAME) ever had a period of two weeks or
more when, nearly every day, (s/he) felt unusually cross or irritable?
.................................................................................
6 1. Yes
209 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM229 CURRENTLY EXPERIENCING THIS EPISODE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH219
At present, is (NAME) still experiencing this episode of sadness, loss of
interest, or irritability?
.................................................................................
9 1. Yes
13 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM230 LIFETIME, NUMBER OF EPISODES
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH220
Since we last visited (him/her), how many episodes of two weeks or more of
sadness, loss of interest or irritability has (NAME) had?
.................................................................................
10 1-5. Number
3 6-10. Number
8 11-95. Number
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
1 998. Don't know
195 Blank. Inap
==========================================================================================
DM232 AGE OF FIRST EPISODE
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH222
How old was (NAME) when (s/he) had (her/his) first episode of two weeks or more
of sadness, loss of interest or irritablilty?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
1 30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
7 70-79. AGE
9 80-89. AGE
3 90-99. AGE
100-109. AGE
2 998. DK (Don't Know)
195 Blank. Inap
==========================================================================================
DM233A APPETITE PROBLEMS WITH EPISODE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH223A
You said that since we last visited (him/her) that (NAME) has had X (from #219)
period(s) of sadness, loss of interest and pleasure, or irritability. With (this
episode)/(these previous episodes), did (s/he) typically experience problems
with:
APPETITE?
.................................................................................
12 1. Yes
9 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM233B SLEEP PROBLEMS WITH EPISODE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH223B
SLEEP?
.................................................................................
11 1. Yes
11 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM233C FEELING SLOWED/RESTLESS WITH EPISODE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH223C
FEELING SLOWED, RESTLESS OR FIDGETY?
.................................................................................
12 1. Yes
9 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM233D ENERGY PROBLEMS WITH EPISODE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH223D
HER/HIS ENERGY LEVEL?
.................................................................................
15 1. Yes
7 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM233E FEELING WORTHLESS/GUILTY WITH EPISODE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH223E
FEELINGS OF WORTHLESSNESS OR GUILT?
.................................................................................
6 1. Yes
16 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM233F CONCENTRATION PROBLEMS WITH EPISODE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH223F
CONCENTRATION?
.................................................................................
5 1. Yes
15 5. No
97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM233G THOUGHTS OF DEATH/SUICIDE WITH EPISODE
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH223G
OR THOUGHTS ABOUT DEATH OR SUICIDE?
.................................................................................
4 1. Yes
18 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM234A TREATED FOR DEPRESSION WITH COUNSELING
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH224A
Since we last visited (him/her), did (NAME) receive any of the following
treatments for depressed mood, clinical depression, or for any of the above
symptoms?
A) COUNSELING
.................................................................................
4 1. Yes
18 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM234B TREATED FOR DEPRESSION WITH MEDICINES
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH224B
B) MEDICINES
.................................................................................
6 1. Yes
15 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM234C TREATED FOR DEPRESSION WITH EST/ECT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH224C
C) ELECTRIC SHOCK OR EST, OR ELECTRIC CONVULSIVE THERAPY OR ECT
.................................................................................
1. Yes
22 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM235 HOSPITALIZED FOR DEPRESSION SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH225
Since we last visited (him/her), has (NAME) been hospitalized for depressed
mood, clinical depression, or any of the symptoms we've just discussed?
.................................................................................
1. Yes
22 5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
195 Blank. Inap
==========================================================================================
DM236 HAD MOOD SWINGS SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH226
Since we last visited (him/her), has (NAME) had mood swings in which (s/he) goes
from being extremely depressed to being excessively happy & energetic?
.................................................................................
7 1. Yes
207 5. No
97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM237 TOLD BY DR WAS BIPOLAR OR MANIC SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH227
Since the last time we visited with [Name], has a doctor told (her/him) that
(s/he) has a bipolar disorder or manic-depressive illness or has (s/he) been
treated for bipolar disorder or manic-depressive illness?
.................................................................................
1 1. Yes
213 5. No
97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM238 AGE WHEN DOCTOR TOLD BIPOLAR OR MANIC
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH228
How old was (s/he) when (s/he) was told (s/he) had bipolar disorder or
manic-depressive illness?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
1 70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
216 Blank. Inap
==========================================================================================
DM239 TREATED FOR BIPOLAR OR MANIC DISORDER
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH229
Since we last visited (her/him), has (NAME) received treatment for bipolar
disorder or manic-depressive illness? [or if Informant has already said
respondent is being treated, state in confirmatory manner, "you said (s/he) is
being treated for this now. Right?"]
.................................................................................
1 1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM240 MEM PXS START BEF/IMM AFT/LAT AFT MOOD SWINGS
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH230
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the mood swings?
.................................................................................
1. Before
2. Immediately After
1 3. Later After
96. Skipped/Not Applicable
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
216 Blank. Inap
==========================================================================================
DM242 TOLD BY DOCTOR HAD SCHIZOPHRENIA SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH232
Since we last visited (Name), has a doctor told (her/him) that (s/he) had
schizophrenia or has (s/he) been treated for schizophrenia?
.................................................................................
1. Yes
214 5. No
97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM243 AGE WHEN DOCTOR TOLD HAD SCHIZOPHRENIA
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH233
How old was (s/he) when a doctor told (her/him) that (s/he) had schizophrenia?
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
70-79. AGE
80-89. AGE
90-99. AGE
100-109. AGE
998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM244 RECEIVE TREATMENT FOR SCHIZOPHRENIA
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH234
Since we last visited (her/him), has (NAME) received treatment for
schizophrenia? [or if Informant has already said Respondent is being treated,
state in confirmatory manner, "you said (s/he) is being treated for this now,
right?"]
.................................................................................
1. Yes
5. No
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
217 Blank. Inap
==========================================================================================
DM245 HAD HALLUCINATIONS OR DELUSIONS SINCE LAST VISIT
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH235
Since we last visited with (Name), has (s/he) ever had hallucinations or
delusions?
.................................................................................
5 1. Yes, hallucinations only
1 2. Yes, delusions only
2 3. Yes, Both
207 5. No
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
1 Blank. Inap
==========================================================================================
DM246 WERE HALLUCINATIONS VISUAL/AUDITORY/BOTH
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH236
Were the hallucinations visual, auditory or both?
.................................................................................
1 1. Visual Only
1 2. Auditory
5 3. Both
97. Not Asked/Not Assessed
98. DK (Don't Know)
99. RF (Refused)
210 Blank. Inap
==========================================================================================
DM247MO MONTH HALLUCINATIONS BEGAN
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH237MO
When did this start? (MONTH)
.................................................................................
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
98. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM247YR YEAR HALLUCINATIONS BEGAN
Section: DM Level: Respondent Type: Numeric Width: 4 Decimals: 0
Ref: MH237YR
When did this start? (YEAR)
.................................................................................
1930-1949. YEAR
1950-1969. YEAR
1970-1979. YEAR
1980-1989. YEAR
1990-1999. YEAR
2000-2009. YEAR
9998. DK (Don't Know)
217 Blank. Inap
==========================================================================================
DM247AGE AGE WHEN HALLUCINATIONS BEGAN
Section: DM Level: Respondent Type: Numeric Width: 3 Decimals: 0
Ref: MH237AGE
When did this start? (AGE)
.................................................................................
1-9. AGE
10-19. AGE
20-29. AGE
30-39. AGE
40-49. AGE
50-59. AGE
60-69. AGE
1 70-79. AGE
4 80-89. AGE
2 90-99. AGE
100-109. AGE
1 998. DK (Don't Know)
209 Blank. Inap
==========================================================================================
DM251AT TYPE OF ICD9 CODE - PROBLEM 1
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH239A_ICD9TYPE
.................................................................................
9 1. Supplementary classification of factors influencing health
status and contact with health services (V01-V83.89)
8 2. Procedure codes (00.0-99.99)
82 3. Medical conditions (001-799.9) and supplemental conditions
--injury and poisoning (800-999.9)
118 Blank. Inap
==========================================================================================
DM251A ICD9 CODE - PROBLEM 1
Section: DM Level: Respondent Type: Character Width: 25 Decimals: 0
Ref: MH239A_ICD9
Since the last time we visited with (him.her), has (NAME) had any other
important medical problems we have not talked about? ICD9 CODE GIVEN
Note: See Data Description and Usage, Appendix 3, ICD 9 Codes and Sub-codes,
for frequencies and meaning of the codes and subcodes.
.................................................................................
==========================================================================================
DM251AS ICD9 SUBCODE - PROBLEM 1
Section: DM Level: Respondent Type: Character Width: 1 Decimals: 0
Ref: MH239A_ICD9_SUB
ICD9 subcode
Note: The subcodes were added to capture characteristics, such as treatment or
sequalae of the medical condition, that might be useful in interpreting the
data. If the ICD-9 codes are the same but the subcodes are different, then the
conditions are considered to be different. Subcodes are required if medical
condition code is: 436.0, 435.9, 294.8, 412, 427.9, 496, 250.00. See Data
Description and Usage, Appendix 3, ICD 9 Codes and Sub-codes, for frequencies
and meaning of the codes and subcodes.
.................................................................................
==========================================================================================
DM251BT TYPE OF ICD9 CODE - PROBLEM 2
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH239B_ICD9TYPE
.................................................................................
5 1. Supplementary classification of factors influencing health
status and contact with health services (V01-V83.89)
5 2. Procedure codes (00.0-99.99)
34 3. Medical conditions (001-799.9) and supplemental conditions
--injury and poisoning (800-999.9)
173 Blank. Inap
==========================================================================================
DM251B ICD9 CODE - PROBLEM 2
Section: DM Level: Respondent Type: Character Width: 25 Decimals: 0
Ref: MH239B_ICD9
Since the last time we visited with (him.her), has (NAME) had any other
important medical problems we have not talked about? ICD9 CODE GIVEN
Note: See Data Description and Usage, Appendix 3, ICD 9 Codes and Sub-codes,
for frequencies and meaning of the codes and subcodes.
.................................................................................
==========================================================================================
DM251BS ICD9 SUBCODE - PROBLEM 2
Section: DM Level: Respondent Type: Character Width: 1 Decimals: 0
Ref: MH239B_ICD9_SUB
ICD9 subcode
Note: The subcodes were added to capture characteristics, such as treatment or
sequalae of the medical condition, that might be useful in interpreting the
data. If the ICD-9 codes are the same but the subcodes are different, then the
conditions are considered to be different. Subcodes are required if medical
condition code is: 436.0, 435.9, 294.8, 412, 427.9, 496, 250.00. See Data
Description and Usage, Appendix 3, ICD 9 Codes and Sub-codes, for frequencies
and meaning of the codes and subcodes.
.................................................................................
==========================================================================================
DM251CT TYPE OF ICD9 CODE - PROBLEM 3
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH239C_ICD9TYPE
.................................................................................
3 1. Supplementary classification of factors influencing health
status and contact with health services (V01-V83.89)
1 2. Procedure codes (00.0-99.99)
17 3. Medical conditions (001-799.9) and supplemental conditions
--injury and poisoning (800-999.9)
196 Blank. Inap
==========================================================================================
DM251C ICD9 CODE - PROBLEM 3
Section: DM Level: Respondent Type: Character Width: 25 Decimals: 0
Ref: MH239C_ICD9
Since the last time we visited with (him.her), has (NAME) had any other
important medical problems we have not talked about? ICD9 CODE GIVEN
Note: See Data Description and Usage, Appendix 3, ICD 9 Codes and Sub-codes,
for frequencies and meaning of the codes and subcodes.
.................................................................................
==========================================================================================
DM251CS ICD9 SUBCODE - PROBLEM 3
Section: DM Level: Respondent Type: Character Width: 1 Decimals: 0
Ref: MH239C_ICD9_SUB
ICD9 subcode
Note: The subcodes were added to capture characteristics, such as treatment or
sequalae of the medical condition, that might be useful in interpreting the
data. If the ICD-9 codes are the same but the subcodes are different, then the
conditions are considered to be different. Subcodes are required if medical
condition code is: 436.0, 435.9, 294.8, 412, 427.9, 496, 250.00. See Data
Description and Usage, Appendix 3, ICD 9 Codes and Sub-codes, for frequencies
and meaning of the codes and subcodes.
.................................................................................
==========================================================================================
DM251DT TYPE OF ICD9 CODE - PROBLEM 4
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH239D_ICD9TYPE
.................................................................................
1 1. Supplementary classification of factors influencing health
status and contact with health services (V01-V83.89)
2. Procedure codes (00.0-99.99)
12 3. Medical conditions (001-799.9) and supplemental conditions
--injury and poisoning (800-999.9)
204 Blank. Inap
==========================================================================================
DM251D ICD9 CODE - PROBLEM 4
Section: DM Level: Respondent Type: Character Width: 25 Decimals: 0
Ref: MH239D_ICD9
Since the last time we visited with (him.her), has (NAME) had any other
important medical problems we have not talked about? ICD9 CODE GIVEN
Note: See Data Description and Usage, Appendix 3, ICD 9 Codes and Sub-codes,
for frequencies and meaning of the codes and subcodes.
.................................................................................
==========================================================================================
DM251DS ICD9 SUBCODE - PROBLEM 4
Section: DM Level: Respondent Type: Character Width: 1 Decimals: 0
Ref: MH239D_ICD9_SUB
ICD9 subcode
Note: The subcodes were added to capture characteristics, such as treatment or
sequalae of the medical condition, that might be useful in interpreting the
data. If the ICD-9 codes are the same but the subcodes are different, then the
conditions are considered to be different. Subcodes are required if medical
condition code is: 436.0, 435.9, 294.8, 412, 427.9, 496, 250.00. See Data
Description and Usage, Appendix 3, ICD 9 Codes and Sub-codes, for frequencies
and meaning of the codes and subcodes.
.................................................................................
==========================================================================================
DM251ET TYPE OF ICD9 CODE - PROBLEM 5
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH239E_ICD9TYPE
.................................................................................
1. Supplementary classification of factors influencing health
status and contact with health services (V01-V83.89)
2. Procedure codes (00.0-99.99)
9 3. Medical conditions (001-799.9) and supplemental conditions
--injury and poisoning (800-999.9)
208 Blank. Inap
==========================================================================================
DM251E ICD9 CODE - PROBLEM 5
Section: DM Level: Respondent Type: Character Width: 25 Decimals: 0
Ref: MH239E_ICD9
Since the last time we visited with (him.her), has (NAME) had any other
important medical problems we have not talked about? ICD9 CODE GIVEN
Note: See Data Description and Usage, Appendix 3, ICD 9 Codes and Sub-codes,
for frequencies and meaning of the codes and subcodes.
.................................................................................
==========================================================================================
DM251ES ICD9 SUBCODE - PROBLEM 5
Section: DM Level: Respondent Type: Character Width: 1 Decimals: 0
Ref: MH239E_ICD9_SUB
ICD9 subcode
Note: The subcodes were added to capture characteristics, such as treatment or
sequalae of the medical condition, that might be useful in interpreting the
data. If the ICD-9 codes are the same but the subcodes are different, then the
conditions are considered to be different. Subcodes are required if medical
condition code is: 436.0, 435.9, 294.8, 412, 427.9, 496, 250.00. See Data
Description and Usage, Appendix 3, ICD 9 Codes and Sub-codes, for frequencies
and meaning of the codes and subcodes.
.................................................................................
==========================================================================================
DM252A MEM PXS START BEF/IMM AFT/LAT AFT MEDICAL PX 1
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH240
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the medical problems?
.................................................................................
58 1. Before
1 2. Immediately After
8 3. Later After
23 96. Skipped/Not Applicable
4 97. Not Asked/Not Assessed
5 98. DK (Don't Know)
99. RF (Refused)
118 Blank. Inap
==========================================================================================
DM252A1 CONDITION CODE MATCH MH240 TIMING TO ITEM IN MH239
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH240C
Condition Code match MH240 timing to Item in MH239
.................................................................................
99 1. Relates to MH239A_ICD9
2. Relates to MH239B_ICD9
3. Relates to MH239C_ICD9
4. Relates to MH239D_ICD9
5. Relates to MH239E_ICD9
118 Blank. Inap
==========================================================================================
DM252B MEM PXS START BEF/IMM AFT/LAT AFT MEDICAL PX 2
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH241
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the medical problems?
.................................................................................
26 1. Before
2. Immediately After
4 3. Later After
11 96. Skipped/Not Applicable
2 97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
173 Blank. Inap
==========================================================================================
DM252B1 CONDITION CODE MATCH MH241 TIMING TO ITEM IN MH239
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH241C
Condition Code match MH241 timing to Item in MH239
.................................................................................
1. Relates to MH239A_ICD9
44 2. Relates to MH239B_ICD9
3. Relates to MH239C_ICD9
4. Relates to MH239D_ICD9
5. Relates to MH239E_ICD9
173 Blank. Inap
==========================================================================================
DM252C MEM PXS START BEF/IMM AFT/LAT AFT MEDICAL PX 3
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH242
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the medical problems?
.................................................................................
9 1. Before
2. Immediately After
3 3. Later After
5 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
3 98. DK (Don't Know)
99. RF (Refused)
197 Blank. Inap
==========================================================================================
DM252C1 CONDITION CODE MATCH MH242 TIMING TO ITEM IN MH239
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH242C
Condition Code match MH242 timing to Item in MH239
.................................................................................
1. Relates to MH239A_ICD9
2. Relates to MH239B_ICD9
20 3. Relates to MH239C_ICD9
4. Relates to MH239D_ICD9
5. Relates to MH239E_ICD9
197 Blank. Inap
==========================================================================================
DM252D MEM PXS START BEF/IMM AFT/LAT AFT MEDICAL PX 4
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH243
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the medical problems?
.................................................................................
4 1. Before
2. Immediately After
3 3. Later After
4 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
2 98. DK (Don't Know)
99. RF (Refused)
204 Blank. Inap
==========================================================================================
DM252D1 CONDITION CODE MATCH MH243 TIMING TO ITEM IN MH239
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH243C
Condition Code match MH243 timing to Item in MH239
.................................................................................
1. Relates to MH239A_ICD9
2. Relates to MH239B_ICD9
3. Relates to MH239C_ICD9
13 4. Relates to MH239D_ICD9
5. Relates to MH239E_ICD9
204 Blank. Inap
==========================================================================================
DM252E MEM PXS START BEF/IMM AFT/LAT AFT MEDICAL PX 5
Section: DM Level: Respondent Type: Numeric Width: 2 Decimals: 0
Ref: MH244
To the best of your recollection, did the memory problems start before,
immediately after or some time later after the medical problems?
.................................................................................
6 1. Before
2. Immediately After
3. Later After
2 96. Skipped/Not Applicable
97. Not Asked/Not Assessed
1 98. DK (Don't Know)
99. RF (Refused)
208 Blank. Inap
==========================================================================================
DM252E1 CONDITION CODE MATCH MH244 TIMING TO ITEM IN MH239
Section: DM Level: Respondent Type: Numeric Width: 1 Decimals: 0
Ref: MH244C
Condition Code match MH244 timing to Item in MH239
.................................................................................
1. Relates to MH239A_ICD9
2. Relates to MH239B_ICD9
3. Relates to MH239C_ICD9
4. Relates to MH239D_ICD9
9 5. Relates to MH239E_ICD9
208 Blank. Inap
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