If you are administering this test to someone else, ask all the questions, including the ones in italics.
If you are administering this test to yourself, skip the questions in italics.
Anyone taking this test must be clear, alert and aware. If the person is sleepy, under the influence of drugs or alcohol, or going through extremely stressful times, the results cannot be trusted.
This Alzheimers test is only meant to bring some awareness in case of serious memory loss. Any worrisome results should be confirmed by a licensed medical professional.
Answer these test questions:
1. I am going to say 3 words. Please remember them. Those words are: boy, cat, pen. Repeat those words. Later on, I will ask you to recall and repeat them. Here they are again: boy, cat, pen.
2. What is your date of birth?
3. What year is it now?
4. What month is it now?
5. Do you know what day of the week it is now? (it may be difficult if you are on a cruise somewhere... Just kidding!)
6. What is today’s date? (the date should be given within one day of the correct date)
7. What city or town are you in right now?
8. Where are you right now? (the person must be clearly aware of the place, such as home, hospital, etc.)
9. Do you know the name of the current president or head of the country?
10. Do you know the name of the previous president or head of the country?
11. Repeat each sentence exactly as I say it:
13. Has your memory caused you significant problems in the past few weeks?
14. Have family members said to you that you are getting much more forgetful?
15. Have friends or acquaintances said to you that you are getting much more forgetful?
16. If you have six apples and give two apples to David and two apples to Laura, how many apples do you have left?
17. Please count, starting at 7 and adding 7 each time: 7, 14, 21, go on...
18. An orange and an apple are both… (what?) A dog and a bird are both… (what?)
19. Has you memory interfered with your ability to take care of your chores around your house, or your job?
20. What food did you eat for your most recent meal?
If the person screened missed five questions or more, it is a good idea to have him or her consult a physician and have some testing done. If this Alzheimers test is self-administered, you are only allowed four incorrect answers!
Once again, if you are worried about any results, please seek medical advice before making any decision.
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