- Level 0: No problem.
- Level 1: Frequent headaches requiring prn meds without interference with daily activities / a history of TIA phenomena (at least one).
- Level 2: Requires daily meds for chronic headaches or headaches that regularly interfere with daily activities / S/P CVA without significant residual / neurodegenerative disease (Parkinson's, MS, ALS, etc) - mild severity.
- Level 3: S/P CVA with mild residual dysfunction / any CNS neurological procedure / neurodegenerative disease - moderate severity.
- Level 4: S/P CVA with residual functional hemiparesis or aphasia / neurodegenerative disease - severe.
Additional Considerations:
Headaches - Frequent headaches requiring prn medication merits a '1,' requiring daily anti-headache prophylaxis or intermittent severe headaches (e.g., migraines that require bed rest) merits a '2.'
TIA's and Strokes - One transient ischemic attack (TIA) merits a '2.' Cerebrovascular accidents (CVA) are rated as above according to the level of residual deficit or disability, for example, a patient who had hemiparesis and speech slurring but regained articular speech and walks with only a slight remaining gait disturbance would be scored a '3.'
Vertigo, Dizziness and Lightheadedness - For consistency these are grouped under ear, nose and throat although this category overlaps with neurology.
Neurodenerative Disease - Parkinson's disease, Multiple Sclerosis, and Amyotrophic Lateral Sclerosis (ALS) are three exams of a wide variety of degenerative neurological diseases. These illnesses are rated according to the severity of impairment at the time of rating, beginning at the '2' level. An example of a '3' would be a parkinsonian patient who shows residual bradykinesia and shuffling gait despite anti-parkinsonia medication, an example of a '4' would be a patient unable to care for their own basic needs bathing, toileting, etc.) because of the severe progression of their illness.
Dementia (see 'Psychiatric Conditions') - Although dementia can be considered a neurological as well as a psychiatric condition, for simplicity it should be grouped under 'psychiatric conditions' as it's effect on function is primarily in this realm. For arbitrary clarity, Alzheimer's disease should be listed only under psych. If the dementia stems from multi-infarct dementia or other neurological condition with concomitant neurological signs or symptoms, both 'neurologic' and 'psychiatric' categories should be endorses at the appropriate level for severity.
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