Autonomic Nervous System Dysfunction Symptom Score Questionnaire18
| None | Sometimes | Always | |
|---|---|---|---|
| Symptoms when you take the supine position | |||
| Is your heart beating fast? | |||
| Is your vision blurred? | |||
| Do you feel dizzy? | |||
| Does your skin become sticky? | |||
| Does your stomach feel uncomfortable? | |||
| Symptoms when you are sweating | |||
| Has your sweating increased in certain areas? | |||
| Has your sweating decreased in certain areas? | |||
| Do you sweat during or after eating? | |||
| Symptoms in the stomach and intestines | |||
| Do you have diarrhea? | |||
| If you have diarrhea, does it get worse at night? | |||
| Are your bowel movements less smooth than before? | |||
| Do you easily feel full before you finish eating? | |||
| Total score: |
Scoring: none, 0; sometimes, 1; always, 2.