1. |
Do you feel the subject has had a significant
decline in memory compared to one year ago? |
2. |
Do the subject tend to repeat questions over
and over? |
3. |
Has the subject been misplacing things more
often? |
4. |
Does it seem to you that lately the subject is
relying more on written reminders (e.g., shopping lists,
calendars)? |
5. |
Does the subject need more help from others to
remember appointments, family occasions or holidays? |
6. |
Does the subject have more trouble recalling
names, finding the right word, or completing sentences? |
7. |
Is the subject having more trouble driving
(e.g., drive more slowly, have more trouble at night, tend to get lost,
have accidents)? |
8. |
Compared to one year ago, is the subject
having more difficulty managing money (e.g., paying bills, calculating
change, completing tax forms)? |
9. |
Is the subject less involved in social
activities? |
10. |
Do you believe, based on your own observations
or comments from the subject’s co-workers, that the
subject’s work performance (paid or volunteer) has declined
significantly, compared to one year ago? |
11. |
Does the subject have more trouble following
the news, or the plots of books, movies or TV shows, compared to one
year ago? |
12. |
Are there any activities (e.g., hobbies, such
as card games, crafts) that are substantially more difficult for the
subject now compared to one year ago? |
13. |
Is the subject more likely to become
disorientated, or get lost, for example when traveling to another
city? |
14. |
Does the subject have more difficulty usin2
household appliances (such as the washing machine, VCR or
computer)? |