Box 2.
Basic demographic information |
name, telephone number, address, name of physician/date of last visit |
date of birth, handedness, yrs of education, parents' yrs of education |
profession/occupation, primary language, height, weight |
referral source, factors leading to participation (e.g., concern about memory, helping research) |
name and relation of collateral informant |
|
Current and past medical and psychiatric history |
overview of health concerns, surgeries, neuroimaging, hearing, vision, medications/dosages |
vitamins, nutritional supplements, hypertension, current blood pressure, cholesterol |
cancer (and consequent treatments), neurological diseases, headaches/migraines, respiration |
arthritis, diabetes, sleep, appetite, balance, incontinence |
alcohol, drug, or nicotine use, depression, anxiety, psychosis, learning or attention difficulties |
family medical and psychiatric history (particularly with regard to memory loss) |
Pre-MRI metal screen |
metal in body or eyes, pacemaker, aneurysm clip, neurostimulator |
dental braces, non-removable retainer, bone fractures treated with screws, rods, pins |
cochlear, otologic, or ear implant |
tattoos or permanent eye liner, claustrophobia |
Description of study |
overview of study goals and assessment techniques (e.g., neuropsychological evaluation, hearing |
test, blood test, hearing test, functional and structural MRI) |
time requirements, stipend |
MATS = Memory and Aging Telephone Screen