Please complete the following:
I am doing the test for myself
If you are concerned for yourself or a loved one who may be experiencing the signs or symptoms of dementia, this screening test may be a good place to start.
This test may indicate a possible problem. When you complete the test, you will receive your test result and a recommendation. So if you feel you cannot do the test yourself, perhaps you might get a trusted loved one to help you complete it.
The areas that the test will examine include:
- Language
- Memory
- Thinking and Problem Solving
- Visual/Spatial Abilities
- Depression
- Substance Abuse
- Head Injury
- Low and High Level Functioning.
Each of the nine areas are scored to indicate whether there are some early problems or what we call Mind Cognitive Impairment exists or something more serious is occurring.
I am doing the test for someone else in my family
Your first name :
Your last name :
Client's Details:
Name :
Gender :
Male
Female
Age :
Years of education :
Contact email :
Contact phone :
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Do not disregard professional medical advice or delay in seeking professional medical treatment, based on the results of this test. This test is not intended to diagnose, treat or cure any health conditions.
Copyright 2010(c) Dr Ross Colquhoun
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