COMPASS-31

Composite Autonomic Symptom Score

The COMPASS-31 is a 31-item questionnaire that measures the severity of autonomic symptoms across six domains. It is widely used in research and clinical practice to assess dysautonomia, POTS, and related conditions.

This is not a diagnostic tool. Your score reflects self-reported symptom severity and does not constitute a diagnosis. Discuss results with your doctor or neurologist. Based on: Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc. 2012;87(12):1196–1201.

Domain 1 Orthostatic intolerance

Symptoms that occur when standing up or remaining upright — such as dizziness, faintness, visual changes, palpitations, or weakness of the legs.

1. When standing for prolonged periods or rising quickly, do you experience symptoms such as dizziness, faintness, lightheadedness, visual blurring, palpitations, tremulousness, or weakness of the legs?

Never Mild — occasionally, doesn't limit activity Moderate — frequently, mildly limits activity Severe — frequently, significantly limits activity Very severe — constantly present, prevents normal activity

2. When these orthostatic symptoms occur, do they improve promptly upon sitting down or lying flat?

3. Have you fainted (lost consciousness) in the past year?

No Yes

4. If you have fainted in the past year, approximately how many times?

Domain 2 Vasomotor

Symptoms related to temperature regulation and sweating.

5. Do you experience heat intolerance — unusual discomfort, worsening of symptoms, or inability to tolerate warm environments?

6. Have you noticed decreased sweating in your feet or legs compared to what it used to be?

7. Have you noticed excessive or compensatory sweating in areas that still sweat normally (such as the face, head, or trunk)?

Domain 3 Secretomotor

Symptoms related to dryness of the mouth, eyes, and throat.

8. Do you experience significant dryness of the mouth?

Never Mild — occasionally dry Moderate — frequently dry Severe — constantly dry, need to sip water frequently Very severe — interferes with eating and speaking

9. Do you experience significant dryness of the eyes?

10. Do you have difficulty swallowing because of a dry mouth or throat?

11. Do you experience significant dryness of the skin overall?

Domain 4 Gastrointestinal

Symptoms related to digestion and gut function. The autonomic nervous system plays a major role in gut motility.

12. Do you experience constipation (fewer than 3 bowel movements per week, or very hard/difficult stools)?

13. Do you experience diarrhoea?

14. Do you experience alternating constipation and diarrhoea?

15. Do you experience nausea?

16. Do you experience vomiting?

17. Do you feel full unusually quickly when eating (early satiety)?

18. Do you experience bloating or abdominal distension after meals?

19. Do you experience difficulty swallowing solid food?

20. Have you had unintentional weight loss of more than 5 kg in the past year?

No Yes, 5–10 kg Yes, more than 10 kg

21. Do you experience abdominal pain or cramping?

22. Do you experience rectal urgency (sudden need to have a bowel movement with very little warning)?

23. Do you experience faecal incontinence?

Domain 5 Bladder

Urinary symptoms related to autonomic control of the bladder.

24. Do you experience urinary urgency or increased frequency of urination?

25. Do you have difficulty starting urination or feel that your bladder doesn't empty completely?

26. Do you experience urinary incontinence (leakage of urine)?

Domain 6 Pupillomotor

Visual symptoms related to autonomic control of pupil size and light adaptation.

27. Do you have difficulty seeing clearly in low light or dim environments?

28. Do your eyes take longer than usual to adjust when moving from bright to dark environments (dark adaptation)?

29. Do you experience blurred vision?

30. Are you abnormally sensitive to bright light (photophobia)?

31. Do you experience pain, aching, or grittiness in or around the eyes?

Your COMPASS-31 score

— out of 100

Domain breakdown

Domain	Your score	Max

How to interpret this score: The COMPASS-31 is a continuous scale from 0 to 100. Higher scores indicate greater autonomic symptom burden. In the validation study (Sletten 2012), healthy controls scored a mean of approximately 5–7, while patients with confirmed autonomic disorders scored between 20–50+ depending on the condition and severity. A score above 16 is commonly used as a threshold suggesting significant autonomic symptoms warranting clinical evaluation.

This tool is for self-monitoring and informational purposes only. It is not a substitute for clinical assessment. If your score suggests significant autonomic symptoms, discuss this with your GP or request a referral to a neurologist or autonomic specialist.