| RPT |
|Ascertain Dementia 8-item Informant Questionnaire (AD8)|
|AD8 Screening scores range from 0-8, with scores in the 0-1 range suggesting
|"NORMAL COGNITION" and scores 2 or greater suggesting "COGNITIVE IMPAIRMENT IS
|LIKELY TO BE PRESENT."
||Note: Scores in the impaired range indicate a need for further diagnostic
|assessment. Scores in the "normal" range suggest that a dementing disorder
|is unlikely, but a very early disease process cannot be ruled out.|
|Question and Answers:|
| 1. Problems with judgement (e.g., problems making decisions, bad financial
| decisions, problems with thinking)
| <*Answer_7926*>
| Date Given: <.Date_Given.>
| 2. Less interest in hobbies/activities
| <*Answer_7927*>
| 3. Repeats the same things over and over (questions, stories, or statements)
| <*Answer_7928*>
| 4. Trouble learning how to use a tool, appliance, or gadget (e.g., VCR,
| computer, microwave, remote control)
| <*Answer_7929*>
| 5. Forgets correct month or year
| <*Answer_7930*>
| 6. Trouble handling complicated financial affairs (e.g., balancing
| Clinician: <.Staff_Ordered_By.>
| checkbook, income taxes, paying bills)
| <*Answer_7931*>
| 7. Trouble remembering appointments
| <*Answer_7932*>
| 8. Daily problems with thinking and/or memory
| <*Answer_7933*>
|
|Copyright 2005. The AD8 is a copyrighted instrument of the Knight Alzheimer
|Disease Research Center, Washington University, St. Louis, Missouri.
|All Rights Reserved. Reproduced with permission|
| Location: <.Location.>|
|Information contained in this note is based on a self-report assessment
|and is not sufficient to use alone for diagnostic purposes. Assessment
|results should be verified for accuracy and used in conjunction with
|other diagnostic activities.
| Veteran: <.Patient_Name_Last_First.>
| SSN: <.Patient_SSN.>
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
| Gender: <.Patient_Gender.>|
|AD8 Dementia Rating Score: <-AD8 TOTAL->, suggesting <*Answer_7771*>|
|
