---

---

QUESTIONNAIRE

A One Minute Test for Parkinson? Disease

As the questions on this test suggest, the early signs of Parkinson? Disease (PD) are similar to signs of old age: moving becomes difficult and slow, balance and posture decline, hands or feet sometimes shake. Someone with PD however, usually experiences a number of these symptoms which may be more severe than signs of old age, making everyday activities very hard to do. There is no cure, but with the right care and understanding, a person with Parkinson? Disease is able to remain active and enjoy life.

Have you noticed:	Yes	No	Maybe
Softer, mumbled speech	Yes	No	Maybe
More saliva in the mouth	Yes	No	Maybe
Stooped over posture	Yes	No	Maybe
Shaking of a hand, foot or other body part	Yes	No	Maybe
Trouble getting out of a car	Yes	No	Maybe
Falling backwards or forwards	Yes	No	Maybe
Difficulty turning over in bed	Yes	No	Maybe
Smaller handwriting	Yes	No	Maybe
Loss of coordination	Yes	No	Maybe
Feet dragging, walking slowly	Yes	No	Maybe
Difficulty starting to walk or stopping	Yes	No	Maybe
Decreased sense of smell	Yes	No	Maybe

If you think you or someone you know might have Parkinson's Disease, getting a diagnosis as soon as possible is important. Early and proper medical attention may be able to help slow the progression of Parkinson's Disease