Dementia Quiz
Questions: 82 · 10 minutes
1. I have made mistakes with money (e.g., double-paying, forgetting to pay, giving incorrect change) that are unusual for me.
Never
Rarely
Sometimes
Often
2. I struggle to follow a conversation in a small group or when there are distractions (e.g., TV on).
Never
Rarely
Sometimes
Often
3. I have trouble recognizing familiar places or people (even if it happens only sometimes).
Never
Rarely
Sometimes
Often
4. I need repeated reminders for basic daily routines (meals, hygiene, medications) more than before.
Never
Rarely
Sometimes
Often
5. I have trouble managing personal hygiene or grooming (e.g., bathing, changing clothes, brushing teeth) without reminders.
Never
Rarely
Sometimes
Often
6. I forget why I entered a room or what I was about to do more than I used to.
Never
Rarely
Sometimes
Often
7. I rely on notes, phone reminders, or other people more than before to remember routine things.
Never
Rarely
Sometimes
Often
8. I feel that it would be safer to discuss these symptoms with a clinician soon rather than waiting.
Strongly disagree
Disagree
Not sure
Agree
9. I have trouble keeping track of my appointments or arriving at the correct time/place without assistance.
Never
Rarely
Sometimes
Often
10. I need reminders from others to complete routine daily responsibilities (e.g., appointments, chores, errands).
Never
Rarely
Sometimes
Often
11. My symptoms are affecting my relationships, work, or independence in a noticeable way.
Not at all
Slightly
Moderately
Significantly
12. I have difficulty shopping independently (e.g., remembering what to buy, managing payment, keeping track of items).
Never
Rarely
Sometimes
Often
13. I feel mentally slower than I used to when thinking things through or making decisions.
Never
Rarely
Sometimes
Often
14. I have missed important appointments or obligations because I forgot about them, even with reminders.
Never
Once
A few times
Frequently
15. The changes are strong enough that I avoid certain activities (driving, cooking, managing money, social events) due to concern.
Not at all
Occasionally
Often
I have stopped multiple activities
16. My difficulties are noticeable in more than one area (memory, language, attention, planning, or orientation).
No, only one area or none
Maybe/unsure
Yes, in a couple of areas
Yes, across many areas
17. I forget recent conversations or events and need others to repeat information.
Never
Rarely
Sometimes
Often
18. I have difficulty finding words or naming familiar people/objects enough that it affects communication.
Not at all
Mildly
Moderately
Severely
19. I have had trouble managing medications safely (missing doses, double-dosing, confusion about what to take).
Never
Once
A few times
Often
20. I get confused when following instructions that have several steps.
Never
Rarely
Sometimes
Often
21. I have difficulty keeping track of the plot or characters in TV shows, books, or news stories in a way that affects enjoyment or understanding.
Never
Rarely
Sometimes
Often
22. My memory/thinking concerns have persisted for at least several months.
No
Yes, a few weeks to 2 months
Yes, about 3–6 months
Yes, longer than 6 months
23. I have had near-misses or problems with driving, navigation, or traffic judgment related to attention or confusion.
Not applicable / no problems
One concern
A few concerns
Repeated or serious concerns
24. I repeat the same question or story because I forget that I already asked or told it.
Never
Rarely
Sometimes
Often
25. I have had episodes of confusion that come on suddenly or seem unusually intense.
Never
Once
A few times
Frequently
26. I get confused about where I placed something and may suspect others moved it when they did not.
Never
Rarely
Sometimes
Often
27. I have trouble following a conversation when there are multiple people talking.
Never
Rarely
Sometimes
Often
28. I have trouble planning or organizing my thoughts when I need to explain something.
Never
Rarely
Sometimes
Often
29. I lose my train of thought in the middle of a conversation or task.
Never
Rarely
Sometimes
Often
30. I need help managing household responsibilities (e.g., cleaning, paying rent/mortgage, keeping up with mail).
Never
Rarely
Sometimes
Often
31. I have trouble handling money tasks (paying bills, balancing accounts, understanding transactions) that I used to manage.
Not at all
Slight difficulty
Moderate difficulty
Severe difficulty
32. Even after rest, stress reduction, or routine changes, the cognitive problems remain noticeable.
No, they resolve
They mostly resolve
They partly resolve
They do not resolve
33. I have had safety-related incidents tied to confusion or forgetfulness (e.g., leaving the stove on, forgetting to lock doors, medication errors).
Never
One minor incident
A few incidents
Multiple or serious incidents
34. I rely on written notes, alarms, or other people more than I used to just to get through the day.
Never
Rarely
Sometimes
Often
35. I need more help than before with routine tasks (shopping, finances, appointments, household chores).
No, not at all
A little help
Some help
A lot of help
36. I have trouble keeping track of what I’m doing when interrupted and then returning to the task.
Never
Rarely
Sometimes
Often
37. I have trouble remembering appointments, dates, or plans even when I try to keep track of them.
Never
Rarely
Sometimes
Often
38. I misunderstand what someone said and need it rephrased more than before (not due to hearing problems).
Never
Rarely
Sometimes
Often
39. I need more help than I used to with paying bills or managing money (e.g., balancing accounts, avoiding late payments).
Never
Rarely
Sometimes
Often
40. I find it hard to concentrate on reading, TV, or a task for as long as I used to.
Never
Rarely
Sometimes
Often
41. I lose track of what I am doing in the middle of a routine task (e.g., cooking, laundry, cleaning).
Never
Rarely
Sometimes
Often
42. I have difficulty doing mental tasks that used to be easy for me (like simple calculations or keeping track of numbers).
Never
Rarely
Sometimes
Often
43. I misplace important items (e.g., keys, wallet, phone) so often that it disrupts my day.
Never
Rarely
Sometimes
Often
44. I lose track of what day, month, or season it is without checking.
Never
Rarely
Sometimes
Often
45. I have trouble following conversations, instructions, or TV plots more than I used to.
Not at all
Rarely
Sometimes
Often
46. I struggle to keep track of dates, time, or what day it is more than I used to.
Never
Rarely
Sometimes
Often
47. I have difficulty planning or completing multi-step tasks (recipes, errands, forms) enough that it causes real problems.
Never
Rarely
Sometimes
Often
48. I substitute vague words (like “thing” or “that stuff”) because I can’t recall specific names.
Never
Rarely
Sometimes
Often
49. My mood, personality, or behavior has changed alongside my memory/thinking concerns (e.g., increased irritability, apathy, suspicion).
Not at all
Slightly
Moderately
Markedly
50. Because of my symptoms, I worry about my safety when alone (at home or outside).
Not at all
A little
Somewhat
Very much
51. I have trouble using familiar household devices I used to manage easily (e.g., microwave, TV remote, phone).
Never
Rarely
Sometimes
Often
52. Someone close to me has expressed concern about my memory, judgment, or confusion.
No
Yes, once or twice
Yes, a few times
Yes, many times
53. I need help organizing or completing paperwork (e.g., forms, insurance, mail) that I used to handle on my own.
Never
Rarely
Sometimes
Often
54. I struggle to recognize faces of people I should know (not just names).
Never
Rarely
Sometimes
Often
55. I have gotten lost, taken a wrong turn, or felt disoriented in a familiar place (e.g., neighborhood, local store).
Never
Rarely
Sometimes
Often
56. I leave the stove, oven, faucet, or lights on because I forget to turn them off.
Never
Rarely
Sometimes
Often
57. I misplace everyday items (like keys, glasses, or my phone) and have trouble retracing my steps to find them.
Never
Rarely
Sometimes
Often
58. I have trouble learning or remembering new information (e.g., a new phone feature, a new route, new names).
Not at all
A little
Somewhat
A lot
59. I frequently misplace important items (e.g., keys, phone, wallet) and cannot retrace my steps to find them.
Never
Rarely
Sometimes
Often
60. I become disoriented about time (for example, thinking it is morning when it is evening).
Never
Rarely
Sometimes
Often
61. I often repeat questions or stories because I forget I already asked or told them.
Never
Rarely
Sometimes
Often
62. I have trouble finding the right words enough that it interferes with everyday communication.
Never
Rarely
Sometimes
Often
63. In the past few months, my symptoms have been getting noticeably worse rather than staying the same.
Not at all
A little
Somewhat
A lot
64. I struggle to find the right word (it feels “on the tip of my tongue”) more than I used to.
Never
Rarely
Sometimes
Often
65. I become easily confused when plans change or something unexpected happens.
Never
Rarely
Sometimes
Often
66. I have trouble recalling details of a recent news story, show, or book soon after I read or watched it.
Never
Rarely
Sometimes
Often
67. I get lost in the middle of a familiar route (walking, driving, or taking transit) and need extra time to re-orient myself.
Never
Rarely
Sometimes
Often
68. I have trouble following multi-step instructions (e.g., a recipe, assembling something, setting up a device).
Never
Rarely
Sometimes
Often
69. I have difficulty preparing a simple meal because I forget steps, ingredients, or whether I already did something.
Never
Rarely
Sometimes
Often
70. My memory or thinking changes have started to interfere with my everyday activities (e.g., managing bills, cooking, medications).
Never
Rarely
Sometimes
Often
71. I forget the names of common objects (for example, calling a “microwave” by the wrong word).
Never
Rarely
Sometimes
Often
72. I forget whether I have taken my medications or taken the correct dose.
Never
Rarely
Sometimes
Often
73. I get confused about what day, month, or time it is in a way that affects my plans.
Never
Rarely
Sometimes
Often
74. I have difficulty handling changes in routine (e.g., a different schedule or unexpected plan) because I become confused or overwhelmed.
Never
Rarely
Sometimes
Often
75. I have moments where I feel unsure of where I am, even in familiar places (like a store or neighborhood).
Never
Rarely
Sometimes
Often
76. I avoid driving or using public transportation because I worry I might get lost or confused.
Never
Rarely
Sometimes
Often
77. I have made poor or risky decisions recently that are out of character (e.g., scams, unsafe driving, impulsive purchases).
Never
Once
More than once
Several times
78. I have gotten lost, disoriented, or unsure of where I was in a familiar place recently.
Never
Once
More than once
This happens repeatedly
79. I have difficulty learning how to use a familiar device or app after a change or update.
Never
Rarely
Sometimes
Often
80. I repeat the same questions or stories because I forget that I already asked or told them.
Never
Rarely
Sometimes
Often
81. I forget names of people I know well or see often.
Never
Rarely
Sometimes
Often
82. I find myself re-reading the same paragraph or re-checking things because I didn’t absorb them the first time.
Never
Rarely
Sometimes
Often