1. Do you forget things during the
day (phone numbers, names,
errands to do) that you don’t
recall—even much later?

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2. Do you get distracted or forgetful
to the point of forgetting that you
just did something (preparing a
meal, leaving food on the stove)?

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3. Do you ever have problems finding the
right word—and feel very embarrassed
about what you say as a result?

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4. Do you ever forget the time or date
to the point where you don’t even realize
where you are?

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5. Do you get so immersed in things
that you forget what you were
doing and why?

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6. Are tasks seeming much more complex
or complicated than they used to (can’t
balance checkbook, can’t make change,
problems using utensils or tools)?

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7. Do you misplace things to the point
of putting them in inappropriate places (like
keys in the fridge or the newspaper in
the clothes drawer)?

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8. Do you get very anxious and agitated
over forgetting things?

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9. Are you sometimes feeling suspicious or
paranoid over not being able to find
familiar things?

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10. Do you need to be reminded, prodded
or prompted to do something you used
to do on your own initiative?

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While any response of “maybe” or “definitely” should be evaluated, if you answered “yes” to 3 or more questions, you should ask for a referral for a comprehensive memory assessment.