Memory Health Tool

powered by healthline

Average Ratings

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1.
Have you noticed that your loved one is having memory problems or that they seem to be unable to concentrate on things they have done in the past (e.g. travel, hobbies, balance a checkbook, manage finances, etc.)?
Yes
No
2.
Have you noticed your loved one having problems doing familiar tasks, such as getting the mail or getting dressed,for reasons other than physical problems?
Yes
No
3.
Have you noticed that your loved one has problems finding the right word to say?
Yes
No
4.
Have you noticed that your loved one uses "nonsense" or made-up words (i.e., the grass is green = the grass is "gleep")?
Yes
No
5.
Does your loved one become lost easily or does not know what day of the week it is?
Yes
No
6.
Have you noticed that your loved one doesn't seem to be taking care of themselves like they used to (i.e., such as not bathing, or combing their hair)?
Yes
No
7.
Does your loved one misplace things, such as keys, and then are found in odd places, like the refrigerator?
Yes
No
8.
Have you noticed changes in your loved one's mood, personality or behavior (especially in social settings)?
Yes
No
9.
Have you noticed your loved one is losing interest in things they normally like to do?
Yes
No

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Disclaimer: This tool is not intended to provide you or your loved one with a diagnosis. A diagnosis for this condition may be made only after being evaluated by a health care provider. You should contact your health care provider if your answers to the tool indicate the possibility that you have a memory issue or concern. Note: We follow all Federal and State laws to protect your health information. Your health insurance rates will not be affected if you use this assessment. Completing this assessment is completely voluntary.
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