Alzheimer's Disease Symptom Screener

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.

Is your loved one forgetting things more often, such as appointments, people's names, or telephone numbers? Is this forgetfulness affecting his or her ability to get things done? Yes   No Is the person having a hard time doing familiar tasks, such as buttoning his or her shirt, paying bills, or using the VCR or DVD player? Yes   No Is the person putting things in strange places, such as placing keys in the refrigerator? Yes   No Is the person under your care forgetting common words or losing his or her train of thought while talking with you? Yes   No Is the person having a hard time doing complex tasks, such as balancing a checkbook or keeping track of plots in movies and books? Yes   No Have you noticed that the changes in the person's behavior are leaving the person confused, suspicious, or afraid? Yes   No Is the person sometimes confused about what day it is or how to get to familiar places, such as his or her own home or the store? Yes   No 8. Has the person lost interest in hobbies, clubs, or other things he or she once enjoyed? Yes   No Have you noticed that the person is avoiding other people, including family and friends? Yes   No Does the person have a harder time now making choices than in the past? Yes   No