Research.net Powered Online Survey

Welcome to MindMate Research!

Health research changes people’s lives every day. Researchers still need your help. Many studies end early because there are not enough volunteers. We want to advance research and help by matching you with research studies. More information about the eligibility criteria:

- Male or female
- 18-85 years of age
- If you qualify and complete the study you may be compensated for time and travel

Your name and contact information will not be shared and your answers will remain confidential. We will not use your information for any purpose other than to screen you for potential participation in this research study.

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1. Do you have symptoms of memory loss?

Yes

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2. Has your memory become worse in the last 12 months?

Yes

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3. Do you feel your memory issues have a significant impact on your daily life?

Yes

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4. Do you think you may be suffering from Alzheimers Disease?

Yes

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5. Is your memory loss caused by stroke, cardiovascular issues, or any other pre-existing condition?

Yes

N/A

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6. Are you diagnosed with any of the following conditions?

Memory Loss (undiagnosed)

Memory Loss (diagnosed by doctor)

Alzheimer's

Dementia

Frontotemporal Dementia

Lewy body dementia

Parkinson's

Diabetes Type 1

Diabetes Type 2

Multiple Sclerosis

Melanoma

Schizophrenia

Psoriatic Arthritis

Bipolar Disorder

Arthritis

Major Depression

Myasthenia Gravis

Migraine

Atopic Dermatitis or Psoriasis

Parkinson's Disease

Huntington's Disease

Lupus

Seizure Disorder

HIV

Hypotension

Healthy Volunteer

Sciatica

Heart Disease

Hypertension

Breast Cancer Survivor

Bladder Pain Syndrome/Interstitial Cystitis

Gout

COPD

Stroke

Metal implants or devices

Fainting spells+

Poorly controlled migraines

Epilepsy

Seizures

Intellectual or developmental disability

Psychotic disorders

Other (please specify)

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7. Please list all the prescription medications that you are currently taking.

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8. Are you taking any medication(s) for cognition, behavior, or mood?

Yes

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9. Are you able to undergo an MRI or PET scan?

Yes

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10. Do you or your loved-one (if filling this out for them) have problems with judgment (e.g., problems making decisions)?

YES - it has become worse

No - there has been no change

N/A - I don't know whether it has become worse

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11. Have you or your loved-one (if filling this out for them) noticed that your interest in hobbies/activities has declined?

YES - it has declined / become less

No - there has been no change

N/A - I don't know whether it has declined/become less

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12. Have you – or a loved one (if filling this out for them) – experienced any of the following behaviors?

See things that other people nearby do not see

Hear things that other people nearby do not hear

Believe that something is true even when there is evidence that it is not true

Agitation (feeling restless or upset)

Aggression (feeling angry)

None of the above

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13. Do you or your loved-one (if filling this out for them) have trouble remembering the correct month or year and has it become worse in the last several years?

YES - it has become worse

No - there has been no change

N/A - I don't know whether it has become worse

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14. Do you or your loved-one (if filling this out for them) repeat the same things over and over (e.g. questions, stories...)

YES - it has become worse

No - there has been no change

N/A - I don't know whether it has become worse

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15. Do you or your loved-one (if filling this out for them) have trouble learning how to use a tool, appliance, or gadget?

YES - it has become worse

No - there has been no change

N/A - I don't know whether it has become worse

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16. Do you or your loved-one (if filling this out for them) have trouble handling complicated financial affairs?

YES - it has become worse

No - there has been no change

N/A - I don't know whether it has become worse

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17. Do you or your loved-one (if filling this out for them) have trouble remembering appointments and has it become worse?

YES - it has become worse

No - there has been no change

N/A - I don't know whether it has become worse

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18. Do you or your loved-one (if filling this out for them) have daily problems with thinking and/or memory and has it become worse?

YES - it has become worse

No - there has been no change

N/A - I don't know whether it has become worse

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19. Do you have a family member or friend who could accompany you to research visits?

Yes