46 Applied Cognition Adult

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Overview

Instructions
Cali App. Cog. General Concerns
Cali App. Cog. Abilities

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Sheet 1: Instructions

Attachment 46
On the next screens, we will ask you questions about organization, memory, speed, concentration, and other abilities that are used in everyday life. Read each question carefully and answer as well as you can. Please consider each question by itself and choose an answer that really shows any problems you may have.	Please answer every question to the best of your ability, thinking about the <u>past 7 days</u>.
After you make your choice, the computer will automatically go on to the next question. If you want to change your answer, click on the GO BACK button to return to the question, then choose a different answer.
Click on the CONTINUE button when you are ready to bigin.

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Sheet 2: Cali App. Cog. General Concerns

Item Context	Item Stem	Rating Scale
In the past 7 days:	I have had trouble forming thoughts	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	My thinking has been slow	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	My thinking has been foggy	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had trouble adding or subtracting numbers in my head	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have made mistakes when writing down phone numbers	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had trouble concentrating	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had trouble finding my way to a familiar place	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had trouble remembering where I put things, like my keys or my wallet	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had trouble remembering whether I did things I was supposed to do, like taking a medicine or buying something I needed	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had trouble remembering new information, like phone numbers or simple instructions	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had trouble recalling the name of an object while talking to someone	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	Words I wanted to use have seemed to be on the “tip of my tongue”	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had trouble finding the right word(s) to express myself	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had trouble speaking fluently	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have walked into a room and forgotten what I meant to get or do there	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have needed medical instructions repeated because I could not keep them straight	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had to work really hard to pay attention or I would make a mistake	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have forgotten names of people soon after being introduced	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	My reactions in everyday situations have been slow	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	Other people have told me I seemed to have trouble remembering information	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	It has seemed like my brain was not working as well as usual	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had to work harder than usual to keep track of what I was doing	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	My thinking has been slower than usual	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had to work harder than usual to express myself clearly	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had more problems conversing with others	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had to use written lists more often than usual so I would not forget things	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had trouble keeping track of what I was doing when interrupted	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had trouble shifting back and forth between different activities that require thinking	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have hidden my problems with memory, concentration, or making mental mistakes so that others would not notice	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have been upset about my problems with memory, concentration, or making mental mistakes	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	My problems with memory, concentration, or making mental mistakes have interfered with my ability to work	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	My problems with memory, concentration, or making mental mistakes have interfered with my ability to do things I enjoy	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	My problems with memory, concentration, or making mental mistakes have interfered with the quality of my life	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)
In the past 7 days:	I have had difficulty multi-tasking	1=Never 2=Rarely (Once) 3=Sometimes (two or three times) 4=Often (about once a day) 5=Very often (several times a day)

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Sheet 3: Cali App. Cog. Abilities

Item Context	Item Stem	Rating Scale
In the past 7 days:	I have been able to bring to mind words that I wanted to use while talking to someone	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to remember where I put things, like my keys or my wallet	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to remember to do things, like take medicine or buy something I needed	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to pay attention and keep track of what I am doing without extra effort	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to think clearly	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	My mind has been as sharp as usual	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	My memory has been as good as usual	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	My thinking has been as fast as usual	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to shift back and forth between two activities that require thinking	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to keep track of what I am doing, even if I am interrupted	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to concentrate	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to form thoughts clearly	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to remember telephone numbers	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to get my point across when talking with someone	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to remember the name of a familiar object	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to think as clearly as usual without extra effort	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to remember things as easily as usual without extra effort	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	My ability to remember important dates has been as good as usual	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	My ability to remember names has been as good as usual	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	My ability to keep track of lists has been as good as usual	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	My thinking has been clear	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	My ability to count money has been as good as usual	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	My ability to follow driving directions has been as good as usual	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to handle many tasks at once without losing track of what I was doing	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	My ability to remember things that I need to do has been as good as usual	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to multi-task as easily as usual without extra effort	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to think clearly without extra effort	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	My ability to concentrate has been good	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to focus my attention	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to mentally focus	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to add and subtract numbers in my head without difficulty	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to remember the name of a familiar person	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much
In the past 7 days:	I have been able to learn new things easily, like telephone numbers or instructions	1=Not at all 2=A little bit 3=Somewhat 4=Quite a bit 5=Very much