Welcome to questionaire about Alzheimers and Dementia Disease
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Does your loved one have memory loss?

     
 
If so, is their memory worse than a few years ago?

     
 
If so, is their memory worse than a few years ago?

     
 
Have you had to take over tracking events or appointments, or does the patient forget appointments?

     
 
Do they misplace items more than once a month?

     
 
Do they suspect others of hiding, or stealing items when they cannot find them?

     
 
Does your loved one frequently have trouble knowing the day, date, month, year, and time; or check the date more than once a day?

     
 
Do they become disoriented in unfamiliar places?

     
 
Do they become more confused when not at home or when traveling?

     
 
Excluding physical limitations, do they have trouble handling money, such as tips or calculating change?

     
 
Do they trouble paying bills or doing finances?

     
 
Does your loved one have trouble remembering to take medicines or keeping track of medications taken?

     
 
Do they difficulty driving; or are you concerned about their driving?

     
 
Are they having trouble using appliances, such as the stove, phone, remote control, microwave?

     
 
Excluding physical limitations, are they having difficulty completing home repair or housekeeping tasks?

     
 
Excluding physical limitations, have they given up or cut down on hobbies such as golf, dancing, exercise or crafts?

     
 
Are they getting lost in familiar surroundings, such as their own neighbourhood?

     
 
Is their sense of direction failing?

     
 
Do they have trouble finding words other than names?

     
 
Do they confuse names of family members or friends?

     
 
Do they have trouble recognizing familiar people?

     
 
Scoring: A "yes" to none or just one question probably does not indicate any kind of dementia, although the questionnaire can't rule out very early cases. So don't hesitate to get help if you continue to be concerned. If you answer yes to two or more ques

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