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AD8 Dementia Screening Interview

If you're wondering if your loved one may be experiencing the signs or symptoms of Alzheimer's disease, this brief questionnaire may be a good place to start. Read each question thoroughly, click either "Yes" or "No," and press "Submit" to get results you can print on the next page.

For an accurate assessment of your loved one's symptoms, be sure to answer each question as honestly as you can.

1.

Does your family member have problems with judgment (problems making decisions, bad financial decisions, problems with thinking, etc.)?

Yes, a change
No, no change
Don't know
2.

Does your family member show less interest in hobbies/activities?

Yes, a change
No, no change
Don't know
3.

Does your family member repeat the same things over and over (questions, stories, or statements)?

Yes, a change
No, no change
Don't know
4.

Does your family member have trouble learning how to use a tool, appliance, or gadget (e.g., VCR, computer, microwave, remote control)?

Yes, a change
No, no change
Don't know
5.

Does your family member forget the correct month or year?

Yes, a change
No, no change
Don't know
6.

Does your family member have trouble handling complicated financial affairs (balancing checkbook, income taxes, paying bills, etc.)?

Yes, a change
No, no change
Don't know
7.

Does your family member have trouble remembering appointments?

Yes, a change
No, no change
Don't know
8.

Does your family member have daily problems with thinking or memory?

Yes, a change
No, no change
Don't know

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The Washington University is not affiliated with any company publishing or using this document and does not endorse any products using this document.

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