ADAP System : Alzheimer Detection, Assessment & Prediction System

Please fill out the following form:

Section A: Patient Demographics
Gender

Section B: Medical History
Do you have a family history of Alzheimer's disease or dementia?
Do you have any of the following conditions?

Section C: Basic Cognitive Assessment
Have you noticed any recent changes in your memory?
Do you have difficulty remembering recent events?
Do you have trouble finding the right words?
Do you have difficulty with problem-solving or decision-making?
Are you having trouble remembering healthcare appointments or when to take your medicines?
Have you noticed any changes in the way you tend to react to people or events?
Does anyone express unusual concern about your driving?

Section IV: Lifestyle Factors
Smoking status
Alcohol consumption
Physical activity level

Section E: Physical & Neurological Exam
Reflexes
Muscle tone and strength
Coordination
Balance
Sense of sight and hearing

Section V: Detailed Cognitive & Functional Assessment

A. Memory
Do you have difficulty remembering recent events?
Do you forget appointments or important dates more often than before?
Do you repeat questions or statements during a conversation?
Do you have trouble learning new information?

B. Language
Do you have trouble finding the right words to express yourself?
Do you have difficulty understanding what people are saying?
Do you have trouble following conversations?

C. Executive Function
Do you have difficulty planning and organizing tasks?
Do you have trouble making decisions or solving problems?
Do you find it hard to manage your finances?

D. Visuospatial Skills
Do you have difficulty judging distances?
Do you have trouble finding your way around familiar places?
Do you have trouble recognizing faces?

E. Attention and Concentration
Do you have difficulty focusing your attention?
Are you easily distracted?
Do you have trouble following instructions?

F. Functional Abilities
Do you need assistance with activities of daily living (bathing, dressing, eating)?
Do you have difficulty managing your medications?
Do you have difficulty driving or using public transportation?

Section VI: Behavioral and Emotional Changes
Have you noticed any changes in your mood or personality?
Do you feel more anxious or depressed than usual?
Are you more irritable or agitated than usual?
Have you lost interest in activities you used to enjoy?

Section VII: Additional Comments

Section G: Blood-Based Biomarkers

Section H: Basic Cognitive & Functional Assessment Scores

Additional Document (Optional)