Dementia Assessment

Dementia Screening Tool

This screening tool will help determine if your loved one might be exhibiting signs of dementia. Please answer the following questions honestly.

1. Does your loved one frequently forget things they have recently learned?

Yes No

2. Is your loved one forgetting how to perform tasks they’ve done routinely throughout their life?

Yes No

3. Does your loved one often forget simple words or use incorrect words in conversations?

Yes No

4. Does your loved one often get lost in familiar places?

Yes No

5. Has your loved one made risky decisions they wouldn’t have made before, such as wearing inappropriate clothing for the weather?

Yes No

6. Does your loved one have difficulty understanding abstract concepts, such as time or money?

Yes No

7. Does your loved one frequently put objects in unusual spots, like an iron in the freezer?

Yes No

8. Have you noticed severe mood swings in your loved one, such as unexplained anger or sadness?

Yes No

9. Has your loved one shown a lack of interest in hobbies or activities they previously enjoyed?

Yes No

10. Does your loved one have difficulty judging distances and spatial relationships?

Yes No

Disclaimer: This assessment is a preliminary tool and cannot replace a professional medical diagnosis. If you have concerns about your loved one's cognitive health, please seek advice from a qualified healthcare provider.

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