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 "Yes," "No," or "Don't know," 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. Only a health care professional can provide a proper diagnosis of your loved one.
Keep in mind that many factors or conditions can cause the symptoms described in this questionnaire. This questionnaire is not intended to be a diagnosis or indication of Alzheimer's disease. Alzheimer's disease is a serious condition that only a doctor or health care professional can diagnose.