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NSI-189 review
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* Indicates required question
What's your longecity nick?
*
Your answer
What's your age?
*
Choose
Under 18
18-20
21-23
24-30
31-40
41-50
51-60
61-70
Over 70
What sex are you?
*
Choose
Male
Female
When did you start taking NSI-189?
*
MM
/
DD
/
YYYY
When did you stop/are planning to stop the first trial of NSI-189?
MM
/
DD
/
YYYY
What other nootropics have you tried before NSI-189?
Racetams
Amphetamines
Modafinil
Popular supplements
Other:
Have you been diagnosed with a medical condition? If yes; which?
*
Your answer
How well have you been functioning before taking NSI-189?
Couldn't function without support of a 2nd person
1
2
3
4
5
Had balanced and fulfilling life
Clear selection
How often did you feel depressed?
*
Not at all
1
2
3
4
5
Constantly
How often did you feel social anxiety?
*
Not at all
1
2
3
4
5
Constantly
How severe was your PTSD?
Leave empty if not feeling having PTSD
Light
1
2
3
4
5
Severe
Clear selection
What was your average dosage of NSI-189 during the trial?
*
Example: 20mg x2 day
Your answer
What other drugs did you take during the trial?
*
Count caffeine and alcohol in.
Your answer
What side effects did you experience during the trial?
Mark those experienced at least twice during the trial
Light headache/tingling
Real headache
Nausea
Lack of energy
Hunger
Increased heart rate
Other:
How was your mood after the first week of NSI-189 intake?
*
3 should be interpreted as average before NSI-189 trial
Low
1
2
3
4
5
High
How was your sociability after the first week of NSI-189 intake?
*
3 should be interpreted as average before NSI-189 trial
Low
1
2
3
4
5
High
How was your free recall/memory after the first week of NSI-189 intake?
*
3 should be interpreted as average before NSI-189 trial
Low
1
2
3
4
5
High
What other positive effects did you experience during the trial?
*
Please write down your experience.
Your answer
Did the effects persist or did they change after you finished the trial?
*
Leave with "-" if you didn't yet finish the trial.
Your answer
Did you do any cognitive tests before the trial? If yes what was your result?
N-back, digit span, etc.
Your answer
Did you do any cognitive tests during the trial? If yes what was your result?
N-back, digit span, etc.
Your answer
Did you do any cognitive tests after the trial? If yes what was your result?
N-back, digit span, etc.
Your answer
If you've done any medical tests prior and after please write down your results or leave empty.
Your answer
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