Memory Loss Checklist

A Checklist For Concerned Family, Friends, and Caregivers

In older adults, the process of differentiating normal age-associated memory decline from those who might have a clinically significant disorder of memory and cognition can be problematic.

The checklist/quiz below was designed and validated to help screen for older adults who may have memory loss problems associated with mild cognitive impairment (MCI), an intermediate stage between normal cognition and Alzheimer’s disease.

After you have completed this checklist, a report with scoring information will be emailed to you.

Adapted from:

Malek-Ahmadi M, Davis K, Belden CM, Jacobson S, Sabbagh MN. Informant-reported cognitive symptoms that predict amnestic mild cognitive impairment. BMC Geriatr. 2012 Feb 3;12:3. PubMed PMID: 22304759; PubMed Central PMCID: PMC3306194

Malek-Ahmadi M, Davis K, Belden C, Laizure B, Jacobson S, Yaari R, Singh U, Sabbagh MN. Validation and diagnostic accuracy of the Alzheimer’s questionnaire. Age Ageing. 2012 May;41(3):396-9. Epub 2012 Feb 23. PubMed PMID: 22367356; PubMed Central PMCID: PMC3335371.