a test for signs

(a research study)

remember as many items 
from this list 
as you can. the
order does not matter.

read it twice 
then close your eyes 
and see 
how many you 
can recall.

bananas, broccoli, avocado, tissue, pancake mix, juice, 
apples, detergent, celery, milk, soup, eggs

what city do you live in ?
what day of the week is it today ?
what is your birth date ?
how old are you now ?

do you get frustrated 
with or angry at 
family members 
more easily than 
you used to?
do you find it 
more difficult 
to recall words and
names for things?
do you find it 
more difficult 
than it used to be 
to use technology?

name as many words 
as you can 
from the list 
order doesnt matter

do you need help 
keeping up with 
your appointments 
and other places 
you need to be?
do you often get 
impatient with others 
or with situations

match these shapes to the puzzle 

is it harder 
for you to read books
than it used to be
do you lose interest 
in shows and movies 
more frequently
than in the past

do you find it difficult 
to make friends
do you find it 
more difficult 
to drive
or go places
do you find it more
difficult to leave 
the house

what year is it 

recall as many words
from the list

as you can

order does
not matter

do you find it

difficult


(to remember)

tha order