PDQ-39

Full Name *

Due to having Parkinson’s disease, how often during the last month have you.... Please tick one box for each question

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

Never

Occasionally

Sometimes

Often

Always

2. Had difficulty looking after your home, e.g. DIY, housework, cooking? *

Never

Occasionally

Sometimes

Often

Always

3. Had difficulty carrying bags of shopping? *

Never

Occasionally

Sometimes

Often

Always

4. Had problems walking half a mile? *

Never

Occasionally

Sometimes

Often

Always

5. Had problems walking 100 yards? *

Never

Occasionally

Sometimes

Often

Always

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

Never

Occasionally

Sometimes

Often

Always

7. Had difficulty getting around in public? *

Never

Occasionally

Sometimes

Often

Always

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

Never

Occasionally

Sometimes

Often

Always

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

Never

Occasionally

Sometimes

Often

Always

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

Never

Occasionally

Sometimes

Often

Always

11. Had difficulty washing yourself? *

Never

Occasionally

Sometimes

Often

Always

12. Had difficulty dressing yourself? *

Never

Occasionally

Sometimes

Often

Always

13. Had problems doing up buttons or shoe laces? *

Never

Occasionally

Sometimes

Often

Always

13. Had problems doing up buttons or shoe laces? *

Never

Occasionally

Sometimes

Often

Always

14. Had problems writing clearly? *

Never

Occasionally

Sometimes

Often

Always

15. Had difficulty cutting up your food? *

Never

Occasionally

Sometimes

Often

Always

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

Never

Occasionally

Sometimes

Often

Always

17. Felt depressed? *

Never

Occasionally

Sometimes

Often

Always

18. Felt isolated and lonely? *

Never

Occasionally

Sometimes

Often

Always

19. Felt weepy or tearful? *

Never

Occasionally

Sometimes

Often

Always

20. Felt angry or bitter? *

Never

Occasionally

Sometimes

Often

Always

21. Felt anxious? *

Never

Occasionally

Sometimes

Often

Always

22. Felt worried about your future? *

Never

Occasionally

Sometimes

Often

Always

23. Felt you had to conceal your Parkinson’s from people? *

Never

Occasionally

Sometimes

Often

Always

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

Never

Occasionally

Sometimes

Often

Always

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

Never

Occasionally

Sometimes

Often

Always

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

Never

Occasionally

Sometimes

Often

Always

27. Had problems with your close personal relationships? *

Never

Occasionally

Sometimes

Often

Always

28. Lacked support in the ways you need from your spouse or partner? *

Never

Occasionally

Sometimes

Often

Always

If you do not have a spouse or partner tick here

29. Lacked support in the ways you need from your family or close friends? *

Never

Occasionally

Sometimes

Often

Always

30. Unexpectedly fallen asleep during the day? *

Never

Occasionally

Sometimes

Often

Always

31. Had problems with your concentration, e.g. when reading or watching TV? *

Never

Occasionally

Sometimes

Often

Always

32. Felt your memory was bad? *

Never

Occasionally

Sometimes

Often

Always

33. Had distressing dreams or hallucinations? *

Never

Occasionally

Sometimes

Often

Always

34. Had difficulty with your speech? *

Never

Occasionally

Sometimes

Often

Always

35. Felt unable to communicate with people properly? *

Never

Occasionally

Sometimes

Often

Always

36. Felt ignored by people? *

Never

Occasionally

Sometimes

Often

Always

37. Had painful muscle cramps or spasms? *

Never

Occasionally

Sometimes

Often

Always

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

Never

Occasionally

Sometimes

Often

Always

39. Felt unpleasantly hot or cold? *

Never

Occasionally

Sometimes

Often

Always