Brain Health Screener

What is the name of the person who will be taking this test??

No, there haven't been any noticeable issues

They forget some details, but it's not big problem.

They still manage most daily tasks on their own

Activities like cooking and cleaning have become more difficult

They need help with most daily activities nowadays

No, they are pretty aware of their surroundings

They occasionally struggle to remember what they're doing

There are times when they don't seem to know where they are

They frequently forget where they are or what day it is

They repeat themselves occasionally, but it's not a big deal.

They often have difficulty following conversations or participating

They repeat themselves constantly and struggle to follow conversations.

They continue to engage in activities with their usual level of interest

There are slight shifts in mood sometimes but no major personality changes

There have been some noticeable shifts in their behavior / personality recently

Yes, their mood is getting very hard to predict each day

They are able to judge distances and move around safely by themselves

They sometimes struggle with balance, but it's not a consistent issue.

There have been a few instances of tripping or falling in the past months.

There have been a number of trips or falls recently. This has become a real concern.