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  • In the past 7 days I have had to work harder than usual to express myself clearly
  • In the past 7 days My reactions in everyday situations have been slow
  • In the past 7 days My thinking has been foggy
  • In the past 7 days I have had trouble remembering whether I did things I was supposed to do, like taking a medicine or buying something I needed
  • In the past 7 days I have had trouble recalling the name of an object while talking to someone
  • In the past 7 days I have had trouble speaking fluently
  • In the past 7 days Other people have told me I seemed to have trouble remembering information
  • In the past 7 days I have had to use written lists more often than usual so I would not forget things
  • In the past 7 days I have hidden my problems with memory, concentration, or making mental mistakes so that others would not notice
  • In the past 7 days My problems with memory, concentration, or making mental mistakes have interfered with my ability to do things I enjoy
  • In the past 7 days I have been upset about my problems with memory, concentration, or making mental mistakes
  • In the past 7 days I have had trouble remembering where I put things, like my keys or my wallet
  • In the past 7 days I have had trouble adding or subtracting numbers in my head
  • In the past 7 days I have made mistakes when writing down phone numbers
  • In the past 7 days I have had difficulty multi-tasking
  • In the past 7 days I have had trouble remembering new information, like phone numbers or simple instructions
  • In the past 7 days I have walked into a room and forgotten what I meant to get or do there
  • In the past 7 days I have forgotten names of people soon after being introduced
  • In the past 7 days Words I wanted to use have seemed to be on the "tip of my tongue"
  • In the past 7 days My thinking has been slower than usual
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