Protocol - Neuropathy - Autonomic Assessment - Adult

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement Category	Required
Major equipment	No
Specialized training	No
Specialized requirements for biospecimen collection	No
Average time of greater than 15 minutes in an unaffected individual	No

Mode of Administration

Self-administered questionnaire

Lifestage

Adult, Senior

Participants

Adult, aged 18 years and older.

Selection Rationale

The Survey of Autonomic Symptoms (SAS) was vetted against similar protocols and chosen because it is a relatively short, validated protocol that focuses more on autonomic symptoms that characterize small-fiber neuropathies.

Language

English

Standards

Standard	Name	ID	Source
Human Phenotype Ontology	Peripheral Neuropathy	HP:0009830	HPO
caDSR Form	PhenX PX130202 - Neuropathy Autonomic Assessment Adult	6912158	caDSR Form

Derived Variables

None

Process and Review

Expert Review Panel 4 (ERP 4) reviewed the measures in the Neurology, Psychiatric, and Psychosocial domains.

Guidance from ERP 4 included the following:

• Changed name of measure
• Added new protocol
• Created new data dictionary

Protocol Name from Source

Survey of Autonomic Symptoms (SAS)

Source

Zilliox, L., Peltier, A. C., Wren, P. A., Anderson, A., Smith, A. G., Singleton, J. R., Feldman, E. L., Alexander, N. B., & Russell, J. W. (2011). Assessing autonomic dysfunction in early diabetic neuropathy: The Survey of Autonomic Symptoms. Neurology, 76(12), 1099-1105.

General References

Kim, S. H., Lee, K. A., Jin, H. Y., Baek, H. S., & Park, T. S. (2014). Relationship between the Korean Version Survey of the Autonomic Symptoms Score and cardiac autonomic neuropathy parameters in patients with diabetic peripheral neuropathy. Diabetes and Metabolism Journal, 38(5), 349-355.

Protocol ID

130202

Variables

Export Variables

Variable Name	Variable ID	Variable Description	dbGaP Mapping
PX130202_Autonomic_Assessment_Adult_Difficulty_Obtaining_Erection
	PX130202120100	Have you had any of the following health more symptoms during the past 6 months? Do you have difficulty obtaining an erection (men)? show less	N/A
PX130202_Autonomic_Assessment_Adult_Difficulty_Obtaining_Erection_Symptoms_Discomfort
	PX130202120200	If you answered yes in Q12a, how much would more you say the symptom bothers you? show less	N/A
PX130202_Autonomic_Assessment_Adult_Dry_Mouth_Dry_Eyes
	PX130202020100	Have you had any of the following health more symptoms during the past 6 months? Do you have a dry mouth or dry eyes? show less	N/A
PX130202_Autonomic_Assessment_Adult_Dry_Mouth_Dry_Eyes_Symptoms_Discomfort
	PX130202020200	If you answered yes in Q2a, how much would more you say the symptom bothers you? show less	N/A
PX130202_Autonomic_Assessment_Adult_Feet_Colder
	PX130202040100	Have you had any of the following health more symptoms during the past 6 months? Are your feet colder than the rest of your body? show less	N/A
PX130202_Autonomic_Assessment_Adult_Feet_Colder_Symptoms_Discomfort
	PX130202040200	If you answered yes in Q4a, how much would more you say the symptom bothers you? show less	N/A
PX130202_Autonomic_Assessment_Adult_Feet_Pale_Blue
	PX130202030100	Have you had any of the following health more symptoms during the past 6 months? Are your feet pale or blue? show less	N/A
PX130202_Autonomic_Assessment_Adult_Feet_Pale_Blue_Symptoms_Discomfort
	PX130202030200	If you answered yes in Q3a, how much would more you say the symptom bothers you? show less	N/A
PX130202_Autonomic_Assessment_Adult_Leaking_Urine
	PX130202110100	Have you had any of the following health more symptoms during the past 6 months? Do you have leaking of urine? show less	N/A
PX130202_Autonomic_Assessment_Adult_Leaking_Urine_Symptoms_Discomfort
	PX130202110200	If you answered yes in Q11a, how much would more you say the symptom bothers you? show less	N/A
PX130202_Autonomic_Assessment_Adult_Lightheadedness
	PX130202010100	Have you had any of the following health more symptoms during the past 6 months? Do you have lightheadedness? show less	N/A
PX130202_Autonomic_Assessment_Adult_Lightheadedness_Symptoms_Discomfort
	PX130202010200	If you answered yes in Q1a, how much would more you say the symptom bothers you? show less	N/A
PX130202_Autonomic_Assessment_Adult_Nausea_Vomiting_Bloating_Small_Meal
	PX130202080100	Have you had any of the following health more symptoms during the past 6 months? Do you have nausea, vomiting, or bloating after eating a small meal? show less	N/A
PX130202_Autonomic_Assessment_Adult_Nausea_Vomiting_Bloating_Small_Meal_Symptoms_Discomfort
	PX130202080200	If you answered yes in Q8a, how much would more you say the symptom bothers you? show less	N/A
PX130202_Autonomic_Assessment_Adult_Persistent_Constipation
	PX130202100100	Have you had any of the following health more symptoms during the past 6 months? Do you have persistent constipation (less than 1 bowel movement every other day)? show less	N/A
PX130202_Autonomic_Assessment_Adult_Persistent_Constipation_Symptoms_Discomfort
	PX130202100200	If you answered yes in Q10a, how much would more you say the symptom bothers you? show less	N/A
PX130202_Autonomic_Assessment_Adult_Persistent_Diarrhea
	PX130202090100	Have you had any of the following health more symptoms during the past 6 months? Do you have persistent diarrhea (more than 3 loose bowel movements per day)? show less	N/A
PX130202_Autonomic_Assessment_Adult_Persistent_Diarrhea_Symptoms_Discomfort
	PX130202090200	If you answered yes in Q9a, how much would more you say the symptom bothers you? show less	N/A
PX130202_Autonomic_Assessment_Adult_Sweating_Feet_Decreased
	PX130202050100	Have you had any of the following health more symptoms during the past 6 months? Is sweating in your feet decreased compared to the rest of your body? show less	N/A
PX130202_Autonomic_Assessment_Adult_Sweating_Feet_Decreased_Absent
	PX130202060100	Have you had any of the following health more symptoms during the past 6 months? Is sweating in your feet decreased or absent (for example, after exercise or during hot weather)? show less	N/A
PX130202_Autonomic_Assessment_Adult_Sweating_Feet_Decreased_Absent_Symptoms_Discomfort
	PX130202060200	If you answered yes in Q6a, how much would more you say the symptom bothers you? show less	N/A
PX130202_Autonomic_Assessment_Adult_Sweating_Feet_Decreased_Symptoms_Discomfort
	PX130202050200	If you answered yes in Q5a, how much would more you say the symptom bothers you? show less	N/A
PX130202_Autonomic_Assessment_Adult_Sweating_Hands_Increased
	PX130202070100	Have you had any of the following health more symptoms during the past 6 months? Is sweating in your hands increased compared to the rest of your body? show less	N/A
PX130202_Autonomic_Assessment_Adult_Sweating_Hands_Increased_Symptoms_Discomfort
	PX130202070200	If you answered yes in Q7a, how much would more you say the symptom bothers you? show less	N/A

Neurology

Measure Name

Neuropathy

Release Date

November 28, 2017

Definition

A measure to assess neuropathy.

Purpose

This measure can be used to assess the severity of symptoms and disability associated with peripheral neuropathy caused by a number of disorders including tumors, infections, autoimmune diseases, and inherited disorders such as Charcot-Marie-Tooth disease.

Keywords

Neurology, small fiber neuropathy, diabetic neuropathy, clinical neuropathy assessment, autonomic neuropathy, gerontology, aging, geriatrics

Measure Protocols

Protocol ID	Protocol Name
130201	Neuropathy - Clinical Assessment
130202	Neuropathy - Autonomic Assessment - Adult

Publications

There are no publications listed for this protocol.