Find out your risk of having Alzheimer’s disease using this 21-item questionnaire. While this is not a definitive way to diagnose Alzheimer’s, this can help you assess your situation and see if further steps must be taken. It’s still best to consult with your doctor for the right diagnosis and treatment.
Answer Yes or No to the following questions.
1. Does your loved one have memory loss?
2. If yes, is his or her memory worse than a few years ago?
3. Does your loved one repeat questions, statements, or stories in the same day? (2 points)
4. Have you had to take over tracking events or appointments, or does your loved one forget appointments?
5. Does your loved one misplace items more than once per month, or so that he or she can’t find them?
6. Does your loved one suspect others of hiding or stealing items when he or she cannot find them?
7. Does your loved one frequently have trouble knowing the day, date, month, year, or time, or check the date more than once a day? (2 points)
8. Does your loved one become disoriented in unfamiliar places?
9. Does your loved one become more confused outside the home or when traveling?
Functional Ability (excluding physical limitations)
10. Does your loved one have trouble handling money (tips, calculating change)?
11. Does your loved one have trouble paying bills or doing finances? (2 points)
12. Does your loved one have trouble remembering to take medicines or tracking medications taken?
13. Does your loved one have difficulty driving or are you concerned about him or her driving?
14. Is your loved one having trouble using appliances (e.g. microwave, oven, stove, remote control, telephone, alarm clock)?
15. Does your loved one have difficulty completing home repair or other home-related tasks, such as housekeeping?
16. Has your loved one given up or significantly cut back on hobbies such as golf, dancing, exercise, or crafts?
17. Does your loved one get lost in familiar surroundings, such as their own neighborhood? (2 points)
18. Does he or she have a decreased sense of direction?
19. Does your loved one have trouble finding words other than names?
20. Does your loved one confuse names of family members or friends? (2 points)
21. Does your loved one have trouble recognizing familiar people? (2 points)
How to interpret your score: