Informant Questionnaire

Is there a relative of friend of the patient who can fill in a short questionnaire?

Yes No

Print the questionnaire and hand it to the relative or friend.

Fill out the answers from the relative or friend below and click Next.

Compared to two years ago, how does he behave in the situations mentioned below:

Points/Question:
A. Remembering things about family and friends e.g. occupations, birthdays, addresses.
B. Remembering things that have happened recently.
C. Recalling conversations a few days later.
D. Remembering what day and month it is.
E. Remembering where to find things which have been put in a different place from usual.
F. Learning new things in general.
G. Handling financial matters e.g. the pension, dealing with the bank.

Informant Questionnaire: 0 pts
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