Bay Area Medical Information (BAMI.us)
Memory Loss Screening Tool for Caregivers/Family

Answer the questions below to help find out if the memory problems of the person you care for could be symptoms of Alzheimer's disease. You must answer all 11 questions.
Does he/she...

Yes

No

Don't Know

1) ...often repeat themselves or ask the same questions over and over?
     
2) ...more forgetful, that is, having trouble with short-term memory?
     
3) ...need reminders to do things like chores, shopping, or taking medicine?      
4) ...forget appointments, family occasions, or holidays?      
5) ...seem sad, down in the dumps, or cry more often than in the past?
     
6)...started having trouble doing calculations, managing finances, or balancing the checkbook?      
7) ...lost interest in his/her activities such as hobbies, reading, attending church, or other social activities?
     
8) ...started needing help eating, dressing, bathing, or using the bathroom?
     
9) ...become irritable, agitated, suspicious, or started seeing, hearing, or believing things that are not real?
     
10) Are there concerns about his/her driving, for example getting lost or driving unsafely, or has the person had to stop driving? If he/she has never driven, answer "No".
     
11) ...have trouble finding the words he/she wants to say, finishing sentences, or naming people or things?
     
If you answered yes to 5 or more of these questions, there could be a problem.  In that event it is recommended that you consult a physician or nurse practitioner.  To read more about what is normal forgetfulness versus symptoms consistent with significant mental decline, click here Adapted from Mundt JC, Freed DM, Griest JH. Lay person-based screening for early detection of Alzheimer's disease: development and validation of an instrument. J Gerontol Psychol Sci Sco. 2000, 55B: 163-170

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