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Composite Autonomic Symptom Scale (COMPASS-31)
Please email the author for information about obtaining the instrument: Dr. Wolfgang Singer,
NeuroRehab Supplemental - Highly Recommended: Indicated for studies requiring an autonomic measure. Recommended for Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS)
Supplemental - Highly Recommended: Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS) and Parkinson's Disease (PD)*
*Recommendations for use: Indicated for studies evaluating autonomic symptoms in PD across multiple domains and its severity.
Short Description of Instrument
The Composite Autonomic Symptom Scale (COMPASS-31) is an improved, shortened self-assessment of autonomic symptoms, based on the Autonomic Symptom Profile, which examines 6 clinically relevant domains (Orthostatic intolerance, Vasomotor, Secretomotor, Pupillomotor, GI and Bladder).  
It has less of a ceiling effect compared to Scale for Outcomes in Parkinson's Disease Autonomic (SCOPA-AUT) and is well established as the gold standard symptom assessment of autonomic dysfunction. COMPASS-31 has seen widespread use across various autonomic disorders, has been demonstrated to separate multiple system atrophy (MSA) from PD with high sensitivity and specificity, and has been used as outcome measure in all major MSA natural history cohorts, as well as most major therapeutic trials.
The instrument takes approximately 10 minutes or less to complete. The participant should complete this assessment.
ME/CFS-Specific: While the COMPASS-31 questionnaire has been validated and used in ME/CFS studies, it has a limited range of questions regarding orthostatic intolerance. It asks respondents to answer only 4 questions about "feeling faint, dizzy, goofy, or having difficulty thinking soon after standing up from a sitting or lying position." In contrast, it asks 12 questions about gastrointestinal symptoms. The presence or absence of lightheadedness is not ascertained, and there are no questions that address how long the respondent can stand without developing symptoms.
Scoring and Psychometric Properties
Scoring: Higher scores indicate worse or more symptoms. Scores are weighted for each domain and can range from 0 - 100.
Yes/No or Present/Absent questions are scored 0 or 1. Frequency, Severity and Time Course questions are scored on a 0 - 3 Likert scale.
Psychometric Properties: COMPASS-31 total scores demonstrate good internal validity (Cronbach's α = 0.919), test-retest reliability (r(s) = 0.886; P < 0.001) and good convergent validity (r(s) = 0.474; P < 0.001).
By domains:
  • Orthostatic intolerance: 4 questions, max weighted score 40, Cronbach's α 0.92. 
  • Vasomotor: 3 questions, max weighted score 5, Cronbach's α 0.91.
  • Secretomotor: 4 questions, max weighted score 15, Cronbach's α 0.48
  • Gastrointestinal: 12 questions, max weighted score 25, Cronbach's α 0.78.
  • Bladder: 3 questions, max weighted score 10, Cronbach's α 0.62.
  • Pupilomotor: 5 questions, max weighted score 5, Cronbach's α 0.84
Strengths: Well-accepted, widespread use, proven track record in PD, and less ceiling effect compared to SCOPA-AUT.
Weaknesses: Timing "in the past year." Orthostatic symptoms "soon" after standing is vague. "Color changes" may not be autonomic. Dry mouth included but not excessive salivation. Post-prandial lightheadedness not included. Sufficient severity to be treated with medication not included. Dark adaptation not included. Symptoms such as fatigue, dyspnea on exertion not included. Eye focusing problem may not be autonomic. Orthostatic symptoms such as coat-hanger pain, muscle weakness, imbalance not included. Not specific for PD-related autonomic problems. Doesn't ask if improved or worsened by anti-parkinsonian drugs.
Key Reference:
Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31: a refined and abbreviated Composite Autonomic Symptom Score. Mayo Clin Proc. 2012 Dec;87(12):1196-201.
Additional References:
Lipp A, Sandroni P, Ahlskog JE, Fealey RD, Kimpinski K, Iodice V, Gehrking TL, Weigand SD, Sletten DM, Gehrking JA, Nickander KK, Singer W, Maraganore DM, Gilman S, Wenning GK, Shults CW, Low PA. Prospective differentiation of multiple system atrophy from Parkinson disease, with and without autonomic failure. Arch Neurol. 2009 Jun;66(6):742-50.
Newton JL, Okonkwo O, Sutcliffe K, Seth A, Shin J, Jones DE. Symptoms of autonomic dysfunction in chronic fatigue syndrome. QJM. 2007 Aug;100(8):519-26.
Rizzi M, Atzeni F, Airoldi A, Masala IF, Frassanito F, Salaffi F, Macaluso C, Sarzi-Puttini P. Impaired lung transfer factor in fibromyalgia syndrome. Clin Exp Rheumatol. 2016 Mar-Apr;34(2 Suppl 96):S114-9.
Suarez GA, Opfer-Gehrking TL, Offord KP, Atkinson EJ, O'Brien PC, Low PA. The Autonomic Symptom Profile: A new instrument to assess autonomic symptoms. Neurology. 1999 Feb;52(3):523-8.
Treister R, O'Neil K, Downs HM, Oaklander AL. Validation of the composite autonomic symptom scale 31 (COMPASS-31) in patients with and without small fiber polyneuropathy. Eur J Neurol. 2015 Jul;22(7):1124-30.
Document last updated August 2022