Here are a few everyday activities. Please tell us if you have any difficulties with these because of physical, mental or emotional memory problems. Exclude any difficulties you expect to last less than three months a) Dressing, including putting on shoes and socks
b) Walking across a room
c) Bathing or showering
d) Eating such as cutting up your food
e) Getting in or out of bed
f) Getting up from chair after sitting long periods
g) Using the toilet including getting up or down
h) Using a map to figure out how to get around in a strange place
i) Recognizing when you are in physical danger
j) Preparing a hot meal
k) Shopping for groceries
l) Making telephone calls
m) Communication (speech, hearing or eyesight)
n) Taking medication
o) Doing work around the house or garden
p) Managing money such as paying bills and keeping track of expenses
q) Controlling bowel and bladder completely by yourself
r) Doing personal laundry
s) Travelling independently on public transport or drive own car
t) Pulling or pushing large objects

yes
no