Zilliox et al developed the Survey of Autonomic Symptoms to identify symptoms of autonomic dysfunction in patients with early diabetic neuropathy. The authors are from the University of Maryland in Baltimore.



(1) lightheadedness

(2) dry mouth and/or dry eye

(3) feet pale or blue

(4) feet colder than the rest of the body

(5) feet less sweaty than the rest of the body

(6) sweating of feet absent or decreased after exercise or during hot weather

(7) hands sweatier than the rest of the body

(8) nausea, vomiting and/or bloating after eating a small meal

(9) persistent diarrhea (4 or more loose bowel movements per day)

(10) persistent constipation (less than 1 bowel movement every 2 days)

(11) urine leakage

(12) if male, difficulty getting an erection



• The maximum score requires both persistent diarrhea and constipation.

• Feet-related symptoms repesent a third of the symptoms surveyed.

• It is a unclear why the foot changes would be much of a bother.





present, no bother


present, a little bother


presesnt, some bother


present, moderate bother


present, significant both



number of symptoms =

= (number of items present)


total symptom impact score =

= SUM(points for all of the symptoms)



• minimum number of symptoms: 0

• maximum number of symptoms for a female: 11

• maximum number of symptoms for a male: 12

• minimum total symptom impact score: 0

• maximum total symptom impact score for a female: 55

• maximum total symptom impact score for a male: 60

• The higher the total symptoms impact score the more significant the findings are for the patient.


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