5 - Never
4 - Rarely
3 - Sometimes
2 -Often
1 - Very Often
I have had trouble forming thoughts
My thinking has been slow
My thinking has been foggy
I have had trouble adding or subtracting numbers in my head
I have made mistakes when writing down phone numbers
I have had trouble concentrating
I have had trouble finding my way to a familiar place
I have had trouble remembering where I put things, like my keys or my wallet
I have had trouble remembering whether I did things I was supposed to do
I have had trouble remembering new information, like phone numbers or simple instructions
I have had trouble recalling the name of an object while talking to someone
I have had trouble speaking fluently
I have walked into a room and forgotten what I meant to get or do
I have needed medical instructions repeated because I could not keep them straight
I have had to work really hard to pay attention or I would make a mistake
I have forgotten names of people soon after being introduced
My reactions in everyday situations have been slow
Other people have told me I seemed to have trouble remembering information
It has seemed like my brain was not working as well as usual
I have had to work harder than usual to keep track of what I was doing
My thinking has been slower than usual
I have had to work harder than usual to express myself clearly
I have had more problems conversing with others
I have had to use written lists more often than usual so I would not forget things
I have had trouble keeping track of what I was doing when interrupted
I have had trouble shifting between different activities that require thinking
I have hidden my problems with memory, concentration, or mental mistakes so others would not notice
I have been upset about my problems with memory, concentration, or making mental mistakes
My problems with memory, concentration, or making mental mistakes have interfered with my ability to work
My problems with memory, concentration, or making mental mistakes have interfered with my ability to do things I enjoy
My problems with memory, concentration, or making mental mistakes have interfered with the quality of my life
I have had difficulty multi-tasking