Alzheimer's Clinic - Memory Checklist

NO

YES

Does the person often repeat themselves or ask the same question repeatedly?

Is the person more forgetful or having difficulty with short-term memory?

Does the person need reminders to do daily tasks, such as shopping or taking medication?

Does the person forget appointments, family occasions or holidays?

Does the person seem sad, down in the dumps or cry more often than in the past?

Is the person having trouble doing calculations or managing their money?

Has the person lost interest in their usual activities and hobbies, i.e. reading, watching/listening to the news or other social activities?

Does the person need help eating, dressing, bathing or using the bathroom?

Has the person become more irritable, agitated, suspicious or started seeing, hearing or believing things that are not real?

Do you have concerns in relation to their safety when driving?

Does the person have trouble finding words they want to say; do you find yourself finishing sentences or naming people or things on their behalf?