1. Demographics

 
10% of survey complete.

The main aims of this survey are:
1. To determine the present health status of patients with NPH
2. To derive a utility score for NPH which can be used by hospital administrators in cost analysis and cost effectiveness in health care budgets.
3. To determine the impact of NPH on caregivers.

This survey is divided into four main sections. The purpose of this first section is to gather data about yourself and your condition. The second section contains questions to determine a utility score. The third section contains questions that will be used to measure your health status. The fourth section is to be answered by a caregiver if you have one.

It is very important that you answer EVERY question.

Please enter the following data:

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* 1. Please enter the following data:

Gender

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* 2. Gender

Age (enter a numerical value e.g. 60)

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* 3. Age (enter a numerical value e.g. 60)

Do you have current medical problems? Please check ALL that apply.

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* 4. Do you have current medical problems? Please check ALL that apply.

Do you smoke cigarettes?

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* 5. Do you smoke cigarettes?

How much alcohol do you consume in an average week? A drink is 1 beer (341 ml)=5oz (142 ml)wine=1.5oz (43 ml) liquor.

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* 6. How much alcohol do you consume in an average week? A drink is 1 beer (341 ml)=5oz (142 ml)wine=1.5oz (43 ml) liquor.

Please indicate your social situation.

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* 7. Please indicate your social situation.

Please indicate your employment status.

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* 8. Please indicate your employment status.

Where do you currently live?

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* 9. Where do you currently live?

How old were you when you were first diagnosed with Normal Pressure Hydrocephalus? (enter a number e.g. 67)

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* 10. How old were you when you were first diagnosed with Normal Pressure Hydrocephalus? (enter a number e.g. 67)

What were your symptoms? Check ALL that apply.

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* 11. What were your symptoms? Check ALL that apply.

What were the order of appearance of symptoms that you had?

If two symptoms occurred first then click first for both symptoms.
If you did not have one or more of the symptoms then click N/A , (not applicable)

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* 12. What were the order of appearance of symptoms that you had?

If two symptoms occurred first then click first for both symptoms.
If you did not have one or more of the symptoms then click N/A , (not applicable)

  First Second Third N/A
Gait / Movement Disturbance
Dementia / Thinking problems / Memory
Urinary Incontinence
Did you have any of the following conditions prior to diagnosis of Normal Pressure Hydrocephalus?

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* 13. Did you have any of the following conditions prior to diagnosis of Normal Pressure Hydrocephalus?

Is there any one else in your family with Normal Pressure Hydrocephalus?

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* 14. Is there any one else in your family with Normal Pressure Hydrocephalus?

Who made the diagnosis of Normal Pressure Hydrocephalus?

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* 15. Who made the diagnosis of Normal Pressure Hydrocephalus?

What tests did you undergo before a diagnosis of NPH was made?
Check ALL that apply.

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* 16. What tests did you undergo before a diagnosis of NPH was made?
Check ALL that apply.

What is the time interval (in MONTHS) between when symptoms first appeared and when diagnosis was made? Enter a number e.g. 25

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* 17. What is the time interval (in MONTHS) between when symptoms first appeared and when diagnosis was made? Enter a number e.g. 25

Did you have a shunt inserted?

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* 18. Did you have a shunt inserted?

T