Are you concerned that your loved ones’ memory has faded? Do you often have the feeling they are forgetting or misplacing things? In the second half of life, forgetfulness can be normal. However, rather than occasional forgetfulness, it can also indicate a more serious medical conditions such as Mild Cognitive Impairment. Once you notice changes it’s critical to seek for professional assistance.
This Short-IQCODE questionnaire has been developed and validated by healthcare professionals to assess individuals with cognitive impairment 1-4. The Short-IQCODE is not a diagnostic tool and was not designed to be used as such. If you are concerned about any aspect of your memory, it´s best to visit to your doctor. However, this questionnaire could help you to start a conversation with your healthcare professional. You can even print out your results and show them during your appointment.
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Remember what your friends and relatives were like 10 years ago and compare with today by indicating what has improved, stayed the same or got worse. Are you ready?
OBJECTIVE:
EAT-10 helps to measure swallowing difficulties.
It may be important for you to talk with your physician about treatment options for symptoms.
A. INSTRUCTIONS:
Answer each question by writing the number of points in the boxes.
To what extent do you experience the following problems?
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Comiss Score Survey Block
| Last name | First name | |
| Age | Date | |
OBJECTIVE:
EAT-10 helps to measure swallowing difficulties.
It may be important for you to talk with your physician about treatment options for symptoms.
| Symptom | Score | |
|---|---|---|
| Remembering things about family and friends e.g. occupations, birthdays, addresses |
Text Answer
|
0
|
| Remembering things that have happened recently |
Text Answer
|
0
|
| Recalling conversations a few days later |
Text Answer
|
0
|
| Remembering his/her address and telephone number |
Text Answer
|
0
|
| Remembering what day and month it is |
Text Answer
|
0
|
| Remembering where things are usually kept |
Text Answer
|
0
|
| Remembering where to find things which have been put in a different place from usual |
Text Answer
|
0
|
| Knowing how to work familiar machines around the house |
Text Answer
|
0
|
| Learning to use a new gadget or machine around the house |
Text Answer
|
0
|
| Learning new things in general |
Text Answer
|
0
|
| Following a story in a book or on TV |
Text Answer
|
0
|
| Making decisions on everyday matters |
Text Answer
|
0
|
| Handling money for shopping |
Text Answer
|
0
|
| Handling financial matters e.g. the pension, dealing with the bank |
Text Answer
|
0
|
| Handling other everyday arithmetic problems e.g. knowing how much food to buy, knowing how long between visits from family or friends |
Text Answer
|
0
|
| Using intelligence to understand what's going on and to reason things through |
Text Answer
|
0
|
| Final result | 0 | |
SCORING:
Add up the number of points and write your total score in the boxes.
Total Score (max. 40 points)
Reference: The validity and reliability of EAT-10 has been determined.
Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ. Validity and Reliability of the Eating Assessment Tool (EAT-10). Annals of Otology Rhinology & Laryngology 2008;117(12):919-924.
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Reproduced with permission A. F. Jorm. Centre for Mental Health Research. The Australian National University Canberra, Australia .
Jorm AF, Jacomb PA. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychol Med. 1989; 19(4):1015-22.
Jorm AF. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross validation. Psychological Medicine 1994;24: 145–53.
Jorm AF. The Informant Questionnaire on cognitive decline in the elderly (IQCODE): a review. Int Psychogeriatr. 2004 Sep; 16(3):275-93.
Harrison JK, et al. Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the early diagnosis of dementia across a variety of healthcare settings. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD011333.