Table 1 Survey of Autonomic Symptoms (SAS)
Survey of Autonomic Symptoms (SAS) | Q1a. Have you had any of the following health symptoms during the past 6 months? Yes = 1 No = 0 | Q2b. If you answered yes in Q1, how much would you say the symptom bothers you? 1 = Not at all 2 = A little 3 = Some 4 = A moderate amount; 5 = A lot | |||||
|---|---|---|---|---|---|---|---|
1. Do you have lightheadedness? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |
2. Do you have a dry mouth or dry eyes? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |
3. Are your feet pale or blue? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |
4. Are your feet colder than the rest of your body? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |
5. Is sweating in your feet decreased compared to the rest of your body? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |
6. Is sweating in your feet decreased or absent (for example, after exercise or during hot weather)? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |
7. Is sweating in your hands increased compared to the rest of your body? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |
8. Do you have nausea, vomiting, or bloating after eating a small meal? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |
9. Do you have persistent diarrhea (more than 3 loose bowel movements per day)? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |
10. Do you have persistent constipation (less than 1 bowel movement every other day)? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |
11. Do you have leaking of urine? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |
12. Do you have difficulty obtaining an erection (men)? | 1 | 0 | 1 | 2 | 3 | 4 | 5 |