We’re glad you’re here!

Your memory is important.

This should only take about 5 minutes and

your answers are completely confidential.

The quiz is divided into two sections:

1. Early Warning Signs

2. Risk Factors

Tell us about yourself...

Are you:

Male Female
Prefer not to specify

How old are you?

Early Warning Signs

PART 1 : EARLY WARNING SIGNS - QUESTION 01/57

Tend to be forgetful.

Never Rarely Occasionally Frequently Very frequently

Misplace things, such as keys, cell phone or wallet.

Never Rarely Occasionally Frequently Very frequently

Memory seems worse than ten years ago.

Never Rarely Occasionally Frequently Very frequently

Forget why you came into a room.

Never Rarely Occasionally Frequently Very frequently

Have trouble remembering names.

Never Rarely Occasionally Frequently Very frequently

Others say you repeat yourself.

Never Rarely Occasionally Frequently Very frequently

Have trouble remembering what you read shortly afterwards.

Never Rarely Occasionally Frequently Very frequently

Have trouble remembering things that happened recently.

Never Rarely Occasionally Frequently Very frequently

Struggle with brain fog.

Never Rarely Occasionally Frequently Very frequently

Have trouble remembering to take medications or supplements on a consistent basis.

Never Rarely Occasionally Frequently Very frequently

Rely more and more on memory aids or reminders on your phone.

Never Rarely Occasionally Frequently Very frequently

Know something one day but forget it the next.

Never Rarely Occasionally Frequently Very frequently

Forget what you’re going to say in the middle of saying it.

Never Rarely Occasionally Frequently Very frequently

Have trouble following directions that have more than one or two steps.

Never Rarely Occasionally Frequently Very frequently

Have more and more trouble finding the right words.

Never Rarely Occasionally Frequently Very frequently

Back

In Memory Rescue Dr. Amen lists 11 categories of risks for memory loss,

highlighted by the mnemonic BRIGHT MINDS.

See which risks you may have.

Part 2 of 2

Risk Factors

PART 2 : RISK FACTORS - QUESTION 16/57

Blood Flow Risk Factors

Have you had a stroke?

Yes No Do Not Know

Do you have a history of cardiovascular disease including coronary artery disease, heart attacks, heart failure, heart arrhythmias?

Yes No Do Not Know

Do you have prehypertension or hypertension?

Yes No Do Not Know

Do you have erectile dysfunction?

Yes No Do Not Know

Do you exercise less than twice a week?

Yes No Do Not Know

Retirement/Aging

Do you watch more than two hours of television a day?

Yes No Do Not Know

Are you in a job that does not require new learning, or are you retired without a routine for new learning?

Yes No Do Not Know

Do you experience loneliness or social isolation?

Yes No Do Not Know

Inflammation

Do you have gum disease or bleeding gums when brushing?

Yes No Do Not Know

Do you have any symptoms of inflammation in the body, such as C-reactive protein?

Yes No Do Not Know

Do you eat fish less than once a week?

Yes No Do Not Know

Genetics and Family History

Do you have one family member with Alzheimer’s or dementia?

Yes No Do Not Know

Do you have more than one family member with Alzheimer’s or dementia?

Yes No Do Not Know

If you have done a genetic testing, do you have one apolipoprotein E4 gene?

Yes No Do Not Know

If you have done a genetic testing, do you have two E4 genes?

Yes No Do Not Know

Head Trauma

Have you had a single head injury or concussion?

Yes No Do Not Know

Have you had several head injuries without a loss of consciousness?

Yes No Do Not Know

Have you lost your sense of smell?

Yes No Do Not Know

Toxins

Have you smoked cigarettes for ten years or longer (currently or in past)?

Yes No Do Not Know

Have you ever had an alcohol or drug dependence (currently or in past)?

Yes No Do Not Know

Have you ever had chemotherapy or radiation for cancer?

Yes No Do Not Know

Have you ever had chronic exposure to heavy metals, such as lead, cadmium, mercury, arsenic or aluminum?

Yes No Do Not Know

Have you had an exposure to mold?

Yes No Do Not Know

Have you had pesticide exposure, such as being raised on a farm?

Yes No Do Not Know

Have you had general anesthesia twice or more?

Yes No Do Not Know

Mental Health Issues

Have you ever been diagnosed with post-traumatic stress disorder?

Yes No Do Not Know

Have you ever been diagnosed with bipolar disorder?

Yes No Do Not Know

Have you ever been diagnosed with depression?

Yes No Do Not Know

Are you under chronic stress?

Yes No Do Not Know

Immunity/Infection Issues

Have you ever been diagnosed with any autoimmune issues including multiple sclerosis?

Yes No Do Not Know

Do you have asthma?

Yes No Do Not Know

Have you ever had lasting infections, such as chronic Lyme disease or brain issues after COVID-19?

Yes No Do Not Know

Have you ever had cold sores or genital herpes?

Yes No Do Not Know

Neurohormone Deficiencies

Do you have low thyroid levels?

Yes No Do Not Know

Do you have low estrogen levels?

Yes No Do Not Know

Do you have low testosterone levels?

Yes No Do Not Know

Have you had a hysterectomy without estrogen replacement?

Yes No Do Not Know

Do you have a history of prostate cancer with testosterone-lowering treatment?

Yes No Do Not Know

Diabesity

Do you have prediabetes or diabetes?

Yes No Do Not Know

Are you overweight?

Yes No Do Not Know

Sleep Issues

Do you have chronic insomnia?

Yes No Do Not Know

Are you on chronic sleep medication?

Yes No Do Not Know

Have you been diagnosed, or do you suspect you have sleep apnea?

Yes No Do Not Know

Back

11 major risk factors that harm the
brain and steal your mind

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Opps!

Looks like you miss something.

We’re glad you’re here!

Your memory is important.

This should only take about 5 minutes and

your answers are completely confidential.

The quiz is divided into two sections:

1. Early Warning Signs

2. Risk Factors

Tell us about yourself...

Are you:

How old are you?

Part 1 of 2

Early Warning Signs

Tend to be forgetful.

Misplace things, such as keys, cell phone or wallet.

Memory seems worse than ten years ago.

Forget why you came into a room.

Have trouble remembering names.

Others say you repeat yourself.

Have trouble remembering what you read shortly afterwards.

Have trouble remembering things that happened recently.

Struggle with brain fog.

Have trouble remembering to take medications or supplements on a consistent basis.

Rely more and more on memory aids or reminders on your phone.

Know something one day but forget it the next.

Forget what you’re going to say in the middle of saying it.

Have trouble following directions that have more than one or two steps.

Have more and more trouble finding the right words.

Nice Work. You completed Part One.

In Memory Rescue Dr. Amen lists 11 categories of risks for memory loss,

highlighted by the mnemonic BRIGHT MINDS.

See which risks you may have.

Part 2 of 2

Risk Factors

Blood Flow Risk Factors

Have you had a stroke?

Do you have a history of cardiovascular disease including coronary artery disease, heart attacks, heart failure, heart arrhythmias?

Do you have prehypertension or hypertension?

Do you have erectile dysfunction?

Do you exercise less than twice a week?

Retirement/Aging

Do you watch more than two hours of television a day?

Are you in a job that does not require new learning, or are you retired without a routine for new learning?

Do you experience loneliness or social isolation?

Inflammation

Do you have gum disease or bleeding gums when brushing?

Do you have any symptoms of inflammation in the body, such as C-reactive protein?

Do you eat fish less than once a week?

Genetics and Family History

Do you have one family member with Alzheimer’s or dementia?

Do you have more than one family member with Alzheimer’s or dementia?

If you have done a genetic testing, do you have one apolipoprotein E4 gene?

If you have done a genetic testing, do you have two E4 genes?

Head Trauma

Have you had a single head injury or concussion?

Have you had several head injuries without a loss of consciousness?

Have you lost your sense of smell?

Toxins

Have you smoked cigarettes for ten years or longer (currently or in past)?

Have you ever had an alcohol or drug dependence (currently or in past)?

Have you ever had chemotherapy or radiation for cancer?

Have you ever had chronic exposure to heavy metals, such as lead, cadmium, mercury, arsenic or aluminum?

Have you had an exposure to mold?

Have you had pesticide exposure, such as being raised on a farm?

Have you had general anesthesia twice or more?

Mental Health Issues

Have you ever been diagnosed with post-traumatic stress disorder?

Have you ever been diagnosed with bipolar disorder?

Have you ever been diagnosed with depression?

Are you under chronic stress?

Immunity/Infection Issues

Have you ever been diagnosed with any autoimmune issues including multiple sclerosis?

Do you have asthma?

Have you ever had lasting infections, such as chronic Lyme disease or brain issues after COVID-19?

Have you ever had cold sores or genital herpes?

Neurohormone Deficiencies

Do you have low thyroid levels?

Do you have low estrogen levels?

Do you have low testosterone levels?

Have you had a hysterectomy without estrogen replacement?

Do you have a history of prostate cancer with testosterone-lowering treatment?