Dementia Symptom Checklists

If you're unsure whether the signs and symptoms you've seen or experienced require further attention from a doctor, try one of the following checklists to find out.

Firstly, are you answering these questions about yourself, or on behalf of someone you care for?

You are answering these questions about yourself.

I have trouble remembering events that happened recently.
I have more trouble than usual finding the right word.
I have trouble remembering the day and date.
I forget where things are usually kept.
I have difficulty adjusting to any changes in my day-to-day routine.
I have problems understanding things I read or hear or following stories on TV.
I find it hard to follow and join in conversations, particularly in groups.
I have problems handling finances, such as banking or calculating change.
I have difficulty with everyday activities such as cooking a meal I have always cooked well.
I am losing interest in activities I’d normally enjoy.
I have difficulties thinking through problems.
Family and/or friends have commented about my poor memory.

You are answering these questions about someone else who you have known for at least 10 years.

Now we want you to remember what your friend or relative was like 10 years ago and compare it with what they are like now. On the following pages are situations where this person has to use their memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse over the past 10 years. Note the importance of comparing their present performance with 10 years ago. So if 10 years ago this person always forgot where they had left things, and they still do, then this would be considered "Not much change".

Compared with 10 years ago, how is this person at remembering things about family and friends (e.g., occupations, birthdays, addresses)?
Compared with 10 years ago, how is this person at remembering things that have happened recently?
Compared with 10 years ago, how is this person at recalling conversations a few days later?
Compared with 10 years ago, how is this person at remembering their address and telephone number?
Compared with 10 years ago, how is this person at remembering what day and month it is?
Compared with 10 years ago, how is this person at remembering where things are usually kept?
Compared with 10 years ago, how is this person at remembering where to find things that have been put in a different place from usual?
Compared with 10 years ago, how is this person at knowing how to work familiar machines around the house?
Compared with 10 years ago, how is this person at learning to use a new gadget or machine around the house?
Compared with 10 years ago, how is this person at learning new things in general?
Compared with 10 years ago, how is this person at following a story in a book or on TV?
Compared with 10 years ago, how is this person at making decisions on everyday matters?
Compared with 10 years ago, how is this person at handling money for shopping?
Compared with 10 years ago, how is this person at handling finances (e.g., the pension, dealing with the bank)?
Compared with 10 years ago, how is this person at handling other everyday arithmetic problems (e.g., knowing how much food to buy, knowing how long between visits from family or friends)?
Compared with 10 years ago, how is this person at using their intelligence to understand what’s going on and to reason things through?

Responses to the Dementia Symptoms Checklists do not determine a diagnosis of dementia or Alzheimer's disease – they may simply suggest the need for further assessment.