SIDE OF THE FACE. (AS IN THE AFTERMATH OF A STROKE) 0. No 1. Yes, left paralysis 2. Yes, right sided paralysis 3. 9. Not applicable IF RATED 1, 2 OR 3 ASK Q190 OTHERWISE SKIP TO Q191 Q190 What did your doctor say was wrong Q190 Accept here R's belief that they have with your .....? Was the possibility of a had a stroke, unless it is clearly false. If R stroke mentioned? is uncertain, ask about transient weakness 0. No stroke in an arm or leg, and particularly an arm or 1. Probable stroke leg on the same side of the body. 2. Certain stroke 8. No answer 9. Not asked SOMATIC DYSFUNCTION Q191 What has your appetite been like? Do Q191Rate here either a diminution of the you enjoy your food? In the last month, desire for food or a marked increase. Some have you been eating more or less than individuals will continue to eat because usual? they know that not taking a meal can weaken them physically, although they 0. No change in appetite may have lost the desire for food. A 1. Mild decrease in desire for food marked increase may take the form of 2. Severe decrease in desire for food eating or a general increase in the 3. Mild increase in desire for food consumption of carbohydrates. Usually R 4. Severe increase in desire for food will find it difficult to control. 8. No answer 9. Not IF RATED 1 OR 2 ASK Q192, IF RATED 3 OR 4 ASK Q193, IF NEITHER SKIP TO Q194 Q192 Why is that? Q192 Try here to exclude any medical condition or bodily ailment (including 0. NO medical condition or nausea alcohol abuse and heavy smoking) as 1. Poor appetite due to illness or nausea causes of appetite loss. If none of these 8. No answer explains poor appetite rate 0. 9. Not asked Q193 Has it been like that most days in the last month?
SIDE OF THE FACE. (AS IN THE AFTERMATH OF A STROKE) 0. No 1. Yes, left paralysis 2. Yes, right sided paralysis 3. 9. Not applicable IF RATED 1, 2 OR 3 ASK Q190 OTHERWISE SKIP TO Q191 Q190 What did your doctor say was wrong with your .....? Was the possibility of a stroke mentioned? 0. No stroke 1. Probable stroke 2. Certain stroke 8. No answer 9. Not asked Q190 Accept here R's belief that they have had a stroke, unless it is clearly false. If R is uncertain, ask about transient weakness in an arm or leg, and particularly an arm or leg on the same side of the body. SOMATIC DYSFUNCTION Q191 What has your appetite been like? Do you enjoy your food? In the last month, have you been eating more or less than usual? 0. No change in appetite 1. Mild decrease in desire for food 2. Severe decrease in desire for food 3. Mild increase in desire for food 4. Severe increase in desire for food 8. No answer 9. Not Q191Rate here either a diminution of the desire for food or a marked increase. Some individuals will continue to eat because they know that not taking a meal can weaken them physically, although they may have lost the desire for food. A marked increase may take the form of eating or a general increase in the consumption of carbohydrates. Usually R will find it difficult to control. IF RATED 1 OR 2 ASK Q192, IF RATED 3 OR 4 ASK Q193, IF NEITHER SKIP TO Q194 Q192 Why is that? 0. NO medical condition or nausea 1. Poor appetite due to illness or nausea 8. No answer 9. Not asked Q192 Try here to exclude any medical condition or bodily ailment (including alcohol abuse and heavy smoking) as causes of appetite loss. If none of these explains poor appetite rate 0. Q193 Has it been like that most days in the last month?
CFAS-II-questionnaire-part-1-v5-1110081.docx