Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. Questionnairehttps://kind-lab.github.io/vbai-fhir/Questionnaire-dneuroalzheimersdiseasemildcognitiveimpairmeschema#2.2.0
... diagnosis_alz_dementia_mci_gsd_clinical_history1. Gold Standard Diagnosis Does the patient have Major Neurocognitive Disorder - Alzheimer's Type, Mild Cognitive Impairment or other types of dementia confirmed by going through (must fill at least one):: Clinical history:0..1string
... diagnosis_alz_dementia_mci_gsd_functional_inventoryFunctional Inventory:0..1string
... diagnosis_alz_dementia_mci_gsd_cognitive_testingCognitive Testing:0..1string
... diagnosis_alz_dementia_mci_gsd_other_investigationsOther investigations:0..1string
... diagnosis_alz_dementia_mci_causesHave you excluded other causes of cognitive/functional changes (and/or other subtypes)?0..1choiceOptions: 3 options
... diagnosis_alz_dementia_mci_dt2. Disease Type: Specify the disease type in the patient:0..1choiceOptions: 7 options
... diagnosis_alz_dementia_mci_dt_otherIf you selected "other", please specify:0..1stringEnable When: diagnosis_alz_dementia_mci_dt = 'other'
... diagnosis_alz_dementia_mci_etiology3. Etiology: What is the suspected or known etiology in the patient?0..1string
... diagnosis_alz_dementia_mci_etiology_gfGenetic Factors Subcategory0..1stringEnable When: diagnosis_alz_dementia_mci_etiology = 1
... diagnosis_alz_dementia_mci_etiology_gf_otherIf you selected "Other genetic factors", please specify:0..1stringEnable When: diagnosis_alz_dementia_mci_etiology_gf = 1
... diagnosis_alz_dementia_mci_etiology_other_medical_conditionsIf you selected "other medical conditions", please specify:0..1stringEnable When: diagnosis_alz_dementia_mci_etiology = 1
... diagnosis_alz_dementia_mci_etiology_otherIf you selected "other", please specify:0..1stringEnable When: diagnosis_alz_dementia_mci_etiology = 1
... diagnosis_alz_dementia_mci_ds4. Disease Severity: What is the current stage/severity of cognitive impairment or dementia in the patient?0..1string
... diagnosis_alz_dementia_mci_ds_cdrClinical dementia rating (CDR) staging subcategory:0..1choiceEnable When: diagnosis_alz_dementia_mci_ds = 1
Options: 4 options
... diagnosis_alz_dementia_mci_ca_rudas_score5. Cognitive Assessment (must fill at least one): Rowland Universal Dementia Assessment Scale (RUDAS) score:0..1string
... diagnosis_alz_dementia_mci_ca_mmse_scoreMini-Mental State Examination (MMSE) score:0..1string
... diagnosis_alz_dementia_mci_ca_moca_scoreMontreal Cognitive Assessment (MoCA) score:0..1string
... diagnosis_alz_dementia_mci_ca_adas_cog_scoreAlzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) score:0..1string
... diagnosis_alz_dementia_mci_ca_otherOther cognitive assessment tool (Please Specify):0..1string
... diagnosis_alz_dementia_mci_ca_other_scoreOther cognitive assessment tool score:0..1string
... diagnosis_alz_dementia_mci_treatment_obtained6. Treatment Obtained: Has the patient undergone any treatment for Alzheimer's disease or cognitive impairment or other types of dementia?0..1choiceOptions: 2 options
... diagnosis_alz_dementia_mci_treatment_obtained_yesYes0..1stringEnable When: diagnosis_alz_dementia_mci_treatment_obtained = 'yes'
... diagnosis_alz_dementia_mci_treatment_obtained_yes_medicationsMedications:0..1stringEnable When:
... diagnosis_alz_dementia_mci_treatment_obtained_yes_medications_otherIf you selected "Other", please specify:0..1stringEnable When:
... diagnosis_alz_dementia_mci_treatment_obtained_yes_npiNon-pharmacological interventions:0..1stringEnable When:
... diagnosis_alz_dementia_mci_treatment_obtained_yes_npi_otherIf you selected "Other", please specify:0..1stringEnable When:

doco Documentation for this format

Options Sets

Answer options for diagnosis_alz_dementia_mci_causes

  • No
  • Yes
  • Not certain

Answer options for diagnosis_alz_dementia_mci_dt

  • Mild Cognitive Impairment (MCI)
  • Typical Alzheimer's Disease (AD)
  • Frontotemporal Dementia (FTD)
  • Lewy Body Dementia (LBD)
  • Vascular Dementia (VaD)
  • Mixed Dementia (e.g. AD and VaD)
  • Other

Answer options for diagnosis_alz_dementia_mci_ds_cdr

  • CDR 0.5 (Very mild impairment)
  • CDR 1 (Mild impairment)
  • CDR 2 (Moderate impairment)
  • CDR 3 (Severe impairment)

Answer options for diagnosis_alz_dementia_mci_treatment_obtained

  • Yes
  • No
 <status value="active"/> <date value="2024-05-29T18:29:18Z"/> <publisher value="KinD Lab"/> <contact> <name value="KinD Lab"/> <telecom> <system value="url"/> <value value="http://fhir.kindlab.sickkids.ca"/> </telecom> </contact> <item> <linkId value="diagnosis_alz_dementia_mci_gsd_clinical_history"/> <text value="1. Gold Standard Diagnosis Does the patient have Major Neurocognitive Disorder - Alzheimer's Type, Mild Cognitive Impairment or other types of dementia confirmed by going through (must fill at least one):: Clinical history:"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_gsd_functional_inventory"/> <text value="Functional Inventory:"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_gsd_cognitive_testing"/> <text value="Cognitive Testing:"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_gsd_other_investigations"/> <text value="Other investigations:"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_causes"/> <text value="Have you excluded other causes of cognitive/functional changes (and/or other subtypes)?"/> <type value="choice"/> <answerOption> <valueString value="No"/> </answerOption> <answerOption> <valueString value="Yes"/> </answerOption> <answerOption> <valueString value="Not certain"/> </answerOption> </item> <item> <linkId value="diagnosis_alz_dementia_mci_dt"/> <text value="2. Disease Type: Specify the disease type in the patient:"/> <type value="choice"/> <answerOption> <valueString value="Mild Cognitive Impairment (MCI)"/> </answerOption> <answerOption> <valueString value="Typical Alzheimer's Disease (AD)"/> </answerOption> <answerOption> <valueString value="Frontotemporal Dementia (FTD)"/> </answerOption> <answerOption> <valueString value="Lewy Body Dementia (LBD)"/> </answerOption> <answerOption> <valueString value="Vascular Dementia (VaD)"/> </answerOption> <answerOption> <valueString value="Mixed Dementia (e.g. AD and VaD)"/> </answerOption> <answerOption> <valueString value="Other"/> </answerOption> </item> <item> <linkId value="diagnosis_alz_dementia_mci_dt_other"/> <text value="If you selected "other", please specify:"/> <type value="string"/> <enableWhen> <question value="diagnosis_alz_dementia_mci_dt"/> <operator value="="/> <answerString value="'other'"/> </enableWhen> </item> <item> <linkId value="diagnosis_alz_dementia_mci_etiology"/> <text value="3. Etiology: What is the suspected or known etiology in the patient?"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_etiology_gf"/> <text value="Genetic Factors Subcategory"/> <type value="string"/> <enableWhen> <question value="diagnosis_alz_dementia_mci_etiology"/> <operator value="="/> <answerString value="1"/> </enableWhen> </item> <item> <linkId value="diagnosis_alz_dementia_mci_etiology_gf_other"/> <text value="If you selected "Other genetic factors", please specify:"/> <type value="string"/> <enableWhen> <question value="diagnosis_alz_dementia_mci_etiology_gf"/> <operator value="="/> <answerString value="1"/> </enableWhen> </item> <item> <linkId value="diagnosis_alz_dementia_mci_etiology_other_medical_conditions"/> <text value="If you selected "other medical conditions", please specify:"/> <type value="string"/> <enableWhen> <question value="diagnosis_alz_dementia_mci_etiology"/> <operator value="="/> <answerString value="1"/> </enableWhen> </item> <item> <linkId value="diagnosis_alz_dementia_mci_etiology_other"/> <text value="If you selected "other", please specify:"/> <type value="string"/> <enableWhen> <question value="diagnosis_alz_dementia_mci_etiology"/> <operator value="="/> <answerString value="1"/> </enableWhen> </item> <item> <linkId value="diagnosis_alz_dementia_mci_ds"/> <text value="4. Disease Severity: What is the current stage/severity of cognitive impairment or dementia in the patient?"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_ds_cdr"/> <text value="Clinical dementia rating (CDR) staging subcategory:"/> <type value="choice"/> <enableWhen> <question value="diagnosis_alz_dementia_mci_ds"/> <operator value="="/> <answerString value="1"/> </enableWhen> <answerOption> <valueString value="CDR 0.5 (Very mild impairment)"/> </answerOption> <answerOption> <valueString value="CDR 1 (Mild impairment)"/> </answerOption> <answerOption> <valueString value="CDR 2 (Moderate impairment)"/> </answerOption> <answerOption> <valueString value="CDR 3 (Severe impairment)"/> </answerOption> </item> <item> <linkId value="diagnosis_alz_dementia_mci_ca_rudas_score"/> <text value="5. Cognitive Assessment (must fill at least one): Rowland Universal Dementia Assessment Scale (RUDAS) score:"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_ca_mmse_score"/> <text value="Mini-Mental State Examination (MMSE) score:"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_ca_moca_score"/> <text value="Montreal Cognitive Assessment (MoCA) score:"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_ca_adas_cog_score"/> <text value="Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) score:"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_ca_other"/> <text value="Other cognitive assessment tool (Please Specify):"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_ca_other_score"/> <text value="Other cognitive assessment tool score:"/> <type value="string"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_treatment_obtained"/> <text value="6. Treatment Obtained: Has the patient undergone any treatment for Alzheimer's disease or cognitive impairment or other types of dementia?"/> <type value="choice"/> <answerOption> <valueString value="Yes"/> </answerOption> <answerOption> <valueString value="No"/> </answerOption> </item> <item> <linkId value="diagnosis_alz_dementia_mci_treatment_obtained_yes"/> <text value="Yes"/> <type value="string"/> <enableWhen> <question value="diagnosis_alz_dementia_mci_treatment_obtained"/> <operator value="="/> <answerString value="'yes'"/> </enableWhen> </item> <item> <linkId value="diagnosis_alz_dementia_mci_treatment_obtained_yes_medications"/> <text value="Medications:"/> <type value="string"/> <enableWhen> <question value="diagnosis_alz_dementia_mci_treatment_obtained"/> <operator value="="/> <answerString value="'yes'"/> </enableWhen> <enableWhen> <question value="diagnosis_alz_dementia_mci_treatment_obtained_yes"/> <operator value="="/> <answerString value="1"/> </enableWhen> <enableBehavior value="all"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_treatment_obtained_yes_medications_other"/> <text value="If you selected "Other", please specify:"/> <type value="string"/> <enableWhen> <question value="diagnosis_alz_dementia_mci_treatment_obtained"/> <operator value="="/> <answerString value="'yes'"/> </enableWhen> <enableWhen> <question value="diagnosis_alz_dementia_mci_treatment_obtained_yes"/> <operator value="="/> <answerString value="1"/> </enableWhen> <enableWhen> <question value="diagnosis_alz_dementia_mci_treatment_obtained_yes_medications"/> <operator value="="/> <answerString value="1"/> </enableWhen> <enableBehavior value="all"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_treatment_obtained_yes_npi"/> <text value="Non-pharmacological interventions:"/> <type value="string"/> <enableWhen> <question value="diagnosis_alz_dementia_mci_treatment_obtained"/> <operator value="="/> <answerString value="'yes'"/> </enableWhen> <enableWhen> <question value="diagnosis_alz_dementia_mci_treatment_obtained_yes"/> <operator value="="/> <answerString value="1"/> </enableWhen> <enableBehavior value="all"/> </item> <item> <linkId value="diagnosis_alz_dementia_mci_treatment_obtained_yes_npi_other"/> <text value="If you selected "Other", please specify:"/> <type value="string"/> <enableWhen> <question value="diagnosis_alz_dementia_mci_treatment_obtained"/> <operator value="="/> <answerString value="'yes'"/> </enableWhen> <enableWhen> <question value="diagnosis_alz_dementia_mci_treatment_obtained_yes"/> <operator value="="/> <answerString value="1"/> </enableWhen> <enableWhen> <question value="diagnosis_alz_dementia_mci_treatment_obtained_yes_npi"/> <operator value="="/> <answerString value="1"/> </enableWhen> <enableBehavior value="all"/> </item> </Questionnaire>