BrainWave
First
Middle
Last
Sex
Male
Female
Other
Sex
Age
Race
American Indian/Alaskan Native
Asian
Black/African American
Hispanic/Latino
Other
White
Multiracial
Other
Race
Education
None
High School
Bachelors
Masters
Doctorate
Other
Education
Email
Phone
Have you noticed a decline in memory over the last few years?
Yes
No
Have any of your friends or family said that you have forgotten things they have told you?
Yes
No
Do you sometimes have to describe what you are trying to say because you can not find the right word?
Yes
No
Do you find it harder to concentrate or lose your train of thought more often than you used to?
Yes
No
Have you ever had any of the following neurological conditions?
Mild Cognitive Impairment
Dementia
Other chronic medical conditions
Submit
