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Trials
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Clinical
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Trials
for
Clinical
Research
Alzheimer's (Lundbeck) 2.0
Alzheimer's (Lundbeck) 2.0
1.
I am taking this assessment for ...
Myself
My Spouse
A Sibling
A Parent
A Different Loved One
2.
How long have you been experiencing memory problems?
Less than 2 weeks
1-6 Months
6-12 Months
1-2 Years
2-4 Years
More than 4 Years
3.
Which of these bests describe your situation?
Learning - recalling information, remembering events, getting lost, misplacing items Language - difficulty with speech, spelling errors, writing errors
Visuospatial - Impairment in face-object recognition, inability to operate simple implements or orient clothing to the body
Executive Functioning - Reasoning impaired judgment, problem solving, reasoning, poor understanding of safety risks, inability to manage finances, inability to plan complex or sequential activities
Orientation - Time relationships and geographical disorientation
Behavioral / Personality Changes - Agitation, social withdrawal, loss of initiative, decreased interests in previous activities related to home and hobbies
4.
Do you live with anyone?
Yes - Spouse
Yes - Family
Yes - Friend
No – Alone
5.
Would you have someone that could attend appointments with you and commute to Princeton?
Yes
No
Possibly
6.
Does your family have a history of memory problems?
Yes - Parents
Yes - Siblings
Yes - Grandparents
Yes - Uncles / Aunts
No
7.
Do you or your family have a history of cancer?
Yes - Parents
Yes - Siblings
Yes - Grandparents
Yes - Uncles / Aunts
No
8.
Do you have any allergies (i.e., drugs, food, etc.)?
Yes - Drugs
Yes - Food
Yes - Both
No
Other
9.
Do you use illicit drugs / marijuana or consume 2 or more alcoholic beverages per day?
Yes
No
10.
Are you currently breastfeeding?
Yes
No
Not Applicable
11.
Do you currently smoke or use other nicotine containing products?
Yes
No
12.
Have you recently experienced any suicidal thoughts?
Yes
No
13.
Are you on memory medications?
Yes
No
Not Sure
14.
Please tell us about yourself.
Male
Female
Other
15.
How old are you?
50-54
55-64
65-85
86-90
90-100+
Please enter your name.
Please enter your email address.
Please enter your phone number.
Time is Up!
Time's up
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Alzheimer's Quiz (Lundbeck)
