This checklist contains 20 questions about possible symptoms or behaviours relating to dementia. You will need to think about the symptoms, how long they have been happening and how much they are affecting daily life. If you do not wish to answer a question, just move on to the next one. This Is not a diagnosis but may help you discuss your concerns with a GP.
Once you start completing the form, do not close the browser or navigate away from a page, as this will clear your answers and you will have to start from the beginning. If you are completing this form on behalf of someone else, answer the questions from their perspective.
Any data entered in this checklist is not saved by the Alzheimer's Society or any third party. For further information about our website and support please read our organisation privacy policy.
Dementia Support Line