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Rating Your Mental Performance
1. Do you find that you have to write things down or you forget to do them?
3. Do you find it increasingly difficult to stay focused during a long meeting?
4. Do you worry that you won’t remember someone’s name shortly after being introduced? Yes
7. Do you find it more difficult to do simple mathematical calculations in your head like
figuring out the tip on a restaurant check or keeping score during a tennis or card game? Yes
8. Do you get more frustrated than you used to when confronted with a mental challenge? Yes
10. Do you find it is becoming more difficult to follow the plot in a novel or a movie?
11. Is it easier for you to remember something that happened 30 years ago than three days
17. Do you eat food with trans-fatty acids three or more times a week? (Trans-fatty acids are
found in margarine and in processed baked goods and snack foods. If you don’t know the answer to this question, you probably are and should answer yes.)
18. Do you use artificially sweetened foods
19. Is there usually more meat on your plate
20. Do you drink more than two glasses of wine or two alcoholic drinks on most days?
21. Do you eat sweets or dessert every day?
What’s in Your Medicine Cabinet?
22. Do you routinely take any drugs, prescription or over-the-counter medication?
(Routinely is defined as four times a week or more.) See list of drugs below under Are you Taking any of These Drugs?
Each drug that you take gets a yes answer so
more than one yes is possible to this
23. Do you routinely get less than eight
24. Do you use a cell phone without an earphone?
25. Do you have a sedentary lifestyle? (You don’t exercise regularly as defined as 30 minutes of moderate to vigorous exercise at least 3 times a week.)
26. Do you smoke or have you smoked in the last 20 years?
29. Have you ever lived in a place where the house or yard was routinely treated for insects? Yes
31. Do you sleep with an electric blanket or clock radio within 3 feet of your head?
Your Stress Level
32. Are you going through a stressful time in your life?
33. Are you all work and no play? (Rarely engage in leisure activities.)
34. Do you come from a single-parent home?
35. Do you have 3 or more older siblings?
36. Did you lose a parent during childhood or
37. Did you experience physical or emotional abuse as a teen or child?
38. Did you serve in the military during wartime?
Your Medical History
39. Do you have a parent, grandparent or sibling who has suffered from a neurological
disease such as Alzheimer’s, Parkinson’s, or senile dementia or who has had a stroke?
40. Are you more than 20 pounds overweight?
41. Have you been diagnose with either Type I or Type II diabetes?
42. Have you ever been diagnosed with depression?
43. Have you ever experienced a head trauma that resulted in a loss of consciousness?
44. Do you have a history or coronary artery
45. Do you have high blood pressure either treated
Are You Taking Any of These Drugs?
Antacids and Stomach Acid Suppressors
(Tagamet, Pepcid, Prevacid, Axid, Prilosec, Zantac) Pain Relievers
(Aspirin, Percodan, Empirin) Non-aspirin Pain Relievers
(Panadol, Tylenol, Anacin, Acetaminophen) Antidepressants
(Elavil, Norpramin, Sinequan, Tofranil, Aventil, Pamelor, Vivactil) Antipsychotic Drugs
(Haldol) Blood Pressure Lowering Drugs
(Tenormin, Zebeta, Bumex, Catapres, Lasix, Apresoline, Aldactazide,
Capozide, Combipres, Dyazide, HydroDIURIL, Hyzaar, Lopressor-HCT, Lotensin HCT, Maxide,
Microzide, Moduretic, Prinzide, Vaseretic, Zestoretic) Cholesterol Lowering Drugs
(Lipitor, Clestid, Lescol, Mevacor, Pravachol, Zocor)
(Glucotrol, DiaBeta, Glynase, Micronase, Glucophage, Tolinase) Asthma Drugs
(Vanceril, Pulmacort, Rhinocort, Nasalide, Aerobid, Flovent, Nasonex, Aerolate) Antibiotics
(Bactrim, Septra) Anticonvulsant Drugs
(Tegretol, Zarontin, Cerebyx, Mebaral, Phenobarbital, Dilantin, Mysoline,
Depakote, Depakene) Anti-Parkinson’s Drugs
(Carbidopa, Levadopa, Sinemet) Corticosteriods: Antiinflammatory Drugs
(Medrol, Deltasone, Orasone) Estrogens
(An estrogen used as a contraceptive, any estrogen used for hormone replacement therapy) Estrogen Substitutes for Osteoporosis
(Raloxifene, Evista) Nonsteroidal Antiinflammatory Drugs
(NSAIDs) (Celebrex, Advil, Bayer Select Motrin, Midol,
Indocin, Naprosyn, Aleve)
Assessing Your Level of Risk
Each “Yes” answer is worth 1 point. Add up all your “Yes” answers to get your final tally. For question 22, each of the drugs that you take routinely counts a one “Yes” so you can accrue several points for this question. If you scored between 0 and 6, you should follow Tier 1 program for Prevention and Maintenance. Tier 1 is for people who are basically healthy, have reasonably good health habits, and do not have any specific problems. If you scored between 7 and 30, you should follow Tier 2, for Prevention, Repair, and Enhancement. Tier 2 is for people who are at a moderate risk and would like to improve their brain performance and prevent further problems. If you scored above 30, you should follow Tier 3, Recovery and Enhancement. Tier 3 is for people who are at high risk and/or may already be experiencing a noticeable decline in mental ability.
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