A diagnosis of dementia or Alzheimer’s by a medical doctor does not necessarily mean a slow, irreversible decline of cognitive function ending in death.

The following Questionnaire was created by our Medical and Dental Advisory Board (MDAB), and is intended solely for your education. Its purpose is to help you become aware of possible underlying causes for your loved one’s memory issues that their doctor may not have recognized. It is not intended in any way to diagnose illness or disease, nor is it a substitute for the professional advice of a qualified healthcare practitioner. It should take 10-15 minutes to complete. Allow your loved one to fill out as much of this Questionnaire as possible themselves, or consult with them as you work through it together.

We urge you to seek out a specially trained healthcare practitioner if, based on the results of this questionnaire, you find out there are steps that can be taken to treat or prevent the further cognitive decline of your loved one. You can use this information, and information found elsewhere on this website, to advocate for testing and treatment protocols that may save a memory and a life.