Table 5.

Dysphagia Screening Questionnaire For Multiple Sclerosis (DSQMS)^a

This Questionnaire Is To Be Completed By The Patient. The Caregiver May Assist The Patient. Choose The Answer That Best Describes The Situation At The Present Time.
1. How would you describe how easy it is for you to swallow?
a. Very easy
b. Easy
c. Difficult
d. Very difficult
e. Nearly impossible
2. If you have any swallowing problems, are they presently
a. Much better than usual
b. Better than usual
c. About the same as usual
d. Worse than usual
e. Much worse than usual
3. Approximately how often do you cough while eating?
a. Never
b. Rarely
c. Occasionally
d. Frequently
e. Constantly
4. Approximately how often do you choke while eating?
a. Never
b. Rarely
c. Occasionally
d. Frequently
e. Constantly
5. How do you feel about eating? Do you feel anxious about swallowing?
a. Not at all anxious
b. Slightly anxious
c. Moderately anxious
d. Severely anxious
e. Too anxious to eat

Note: ^aAdapted with permission from SAGE Publications. Copyright © 1997. Abraham S, Scheinberg LC, Smith CR, LaRocca NG. Neurologic Impairment and disability status in outpatients with multiple sclerosis reporting dysphagia symptomatology. J Neuro Rehab. 1997;11(1):7–13.³⁶