Instructions: Below is a list of questions that relate to life-experiences common among people who have been diagnosed with dementia. Please read each question carefully, and indicate how often you have experienced the same or similar challenges in the past few months.

Your privacy is important to use. All results are completely anonymous.

Do you ever forget information that you have learned recently?
Do you have to ask for the same information again or need reminder notes?
Do you have trouble following instructions, like a recipe or directions?
Do you struggle to keep track of finances or pay bills on time?
Do you experience visual problems, such as trouble with reading or judging distance or color?
Do you find yourself becoming confused in the middle of a conversation and having to stop?
Do you struggle to remember words, date, or events?
Do you lose things and/or sense that people have stolen them?
Do you struggle to remember to keep yourself clean or practice good hygiene?
Have you or others noticed changes in your personality, such as becoming easily upset or anxious?

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If you think you or someone you care about may be suffering from dementia or any other mental health condition, PsyCom.net strongly recommends that you seek help from a mental health professional in order to receive a proper diagnosis and support. For those in crisis, we have compiled a list of resources (some even offer free or low-cost support) where you may be able to find additional help at: https://www.psycom.net/get-help-mental-health.‚Äč

Last Updated: Nov 14, 2017