Are You or Your Loved one Having Difficulty with Memory?

Sometimes it’s difficult to determine if lapses in memory are normal forgetfulness, or signs of a true memory problem. If you obtain a score of 8 or below, the Memory Clinic may be able to help you. Low scores do not always mean that you have a memory problem.

Instructions

Study these four words for several seconds. When you’re done, answer the following ten questions. At the end of the test, try to remember the four words: Pear   Mrs. Smith   Honor   Bicycle

Yes

No

Question

Can you remember your current telephone number and address?

Can you remember what your had for your last meal?

 

 

What is this man’s name? Type his name in the box.

Have your forgotten to take a dose of your medication during the past month?

Have you misplaced your keys, wallet, purse, eye glasses or other object during the past month?

 

 

What is this woman’s name? Type her name in the box.

 

 

Without using paper or other device, calculate 13 X 4. Type your answer in the box.

Have family or friends told you that you repeat yourself in conversations?

 

 

What is this man’s name? Type his name in the box.

 

 

What were the words you were asked to recall at the beginning of this test?