Due to having Parkinson’s disease, how often during the last month have you…

1. Had difficulty doing the leisure activities you would like to do? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

2. Had difficulty looking after your home, for example, housework, cooking or yardwork? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

3. Had difficulty carrying grocery bags? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

4. Had problems walking half a mile? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

5. Had problems walking 100 yards (approximately 1 block)? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

6. Had problems getting around the house as easily as you would like? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

7. Had difficulty getting around in public places? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

8. Needed someone else to accompany you when you went out? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

9. Felt frightened or worried about falling in public? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

10. Been confined to the house more than you would like? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

11. Had difficulty showering and bathing? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

12. Had difficulty dressing? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

13. Had difficulty with buttons or shoelaces? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

14. Had problems writing clearly? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

15. Had difficulty cutting up your food? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

16. Had difficulty holding a drink without spilling it? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

17. Felt depressed? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

18. Felt isolated and lonely? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

19. Felt weepy or tearful? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

20. Felt angry or bitter? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

21. Felt anxious? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

22. Felt worried about your future? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

23. Felt you had to hide your Parkinson's from people? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

24. Avoided situations which involve eating or drinking in public? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

25. Felt embarrassed in public due to having Parkinson’s disease? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

26. Felt worried about other people's reaction to you? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

27. Had problems with your close personal relationships? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

28. Lacked the support you needed from your spouse or partner? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

I do not have a spouse or Partner

29. Lacked the support you needed from your family or close friends? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

30. Unexpectedly fallen asleep during the day? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

31. Had problems with your concentration, for example when reading or watching TV? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

32. Felt your memory was failing? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

33. Had distressing dreams or hallucinations? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

34. Had difficulty speaking? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

35. Felt unable to communicate effectively? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

36. Felt ignored by people? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

37. Had painful muscle cramps or spasms? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

38. Had aches and pains in your joints or body? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

39. Felt uncomfortably hot or cold? *

Never

Occasionally

Sometimes

Often

Always or cannot do at all

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