Compass 31
Compass 31
Compass 31
Instrument - COMPASS 31
1. In the past year, have you ever felt faint, dizzy, “goofy”, or had difficulty
thinking soon after standing up from a sitting or lying position?
1 Yes
2 No (if you marked No, please skip to question 5)
2. When standing up, how frequently do you get these feelings or symptoms?
1 Rarely
2 Occasionally
3 Frequently
4 Almost Always
4. In the past year, have these feelings or symptoms that you have experienced:
1 Gotten much worse
2 Gotten somewhat worse
3 Stayed about the same
4 Gotten somewhat better
5 Gotten much better
6 Completely gone
5. In the past year, have you ever noticed color changes in your skin, such as
red, white, or purple?
1 Yes
2 No (if you marked No, please skip to question 8)
6. What parts of your body are affected by these color changes? (Check all that
apply)
1 Hands
2 Feet
11. For the symptom of dry eyes or dry mouth that you have had for the longest
period of time, is this symptom:
1 I have not had any of these symptoms
2 Getting much worse
3 Getting somewhat worse
4 Staying about the same
5 Getting somewhat better
6 Getting much better
7 Completely gone
12. In the past year, have you noticed any changes in how quickly you get full
when eating a meal?
1 I get full a lot more quickly now than I used to
2 I get full more quickly now than I used to
3 I haven’t noticed any change
4 I get full less quickly now than I used to
5 I get full a lot less quickly now than I used to
13. In the past year, have you felt excessively full or persistently full (bloated
feeling) after a meal?
1 Never
2 Sometimes
3 A lot of the time
16. In the past year, have you had any bouts of diarrhea?
1 Yes
2 No (if you marked No, please skip to question 20)
24. In the past year, have you ever lost control of your bladder function?
1 Never
2 Occasionally
3 Frequently ____________ times per month
4 Constantly
25. In the past year, have you had difficulty passing urine?
1 Never
2 Occasionally
3 Frequently ____________ times per month
4 Constantly
26. In the past year, have you had trouble completely emptying your bladder?
1 Never
2 Occasionally
3 Frequently ____________ times per month
4 Constantly
27. In the past year, without sunglasses or tinted glasses, has bright light
bothered your eyes?
1 Never (if you marked Never, please skip to question 29)
2 Occasionally
3 Frequently
4 Constantly
29. In the past year, have you had trouble focusing your eyes?
1 Never (if you marked Never, please skip to question 31)
2 Occasionally
3 Frequently
4 Constantly