Skip to main content

Table 1 Memory complaint screening questionnaires (Q1 and Q2)

From: Early detection of memory impairment in people over 65 years old consulting at Health Examination Centers for the French health insurance: the EVATEM protocol

Q1: self-questionnaire

Q2: questionnaire administered by the doctor

 

During the six last months:

1. In the last six months, have any of your close relations suggested that you have a possible memory problem?

1. Have any of your close relations told you that you have memory problems?

2. Do you sometimes suffer from a lapse of memory during daily life?

2. Have you noticed any change in your memory?

3. Do you find it difficult to calculate?

3. Do you think that your memory now works less well than memory of other people of age?

4. Do you have difficulties finding your words?

4. Do you find it difficult to orientate yourself, or did you ever not recognize a place where your close relations have told you that you have been?

5. Do you have problems remembering new information?

5. Have you ever fogotten everything about an event (even if your close relations told you about it or you saw pictures about it)?

6. Do you find it difficult to focus?

Â