Personal Assessment Test 1. Are you experiencing prolonged periods of high stress or anxiety in your life?
2. Do you frequently find yourself feeling depressed discouraged or hopeless?
3. Have you ever been diagnosed with Attention Deficit Disorder, or do you find it hard to focus or concentrate?
4. Do you forget more than you used to, or find it hard at times to recall the right words or names of people you know well?
5. Are you more easily disoriented or confused now than you were 5 years ago?
6. Have you, or the person you are taking this for, been diagnosed with Alzheimer’s?
7. Have you, or the person you are taking this for, been diagnosed with dementia, other than Alzheimer’s?
8. Did either of your biological parents, grandparents, aunts, or uncles have Alzheimer’s? Or have you been told you have a genetic predisposition for Alzheimer’s?
9. Did either of your biological parents, grandparents, aunts, or uncles have some other form of dementia (a major loss of cognitive abilities) from causes other than Alzheimer’s.
10. Have you been diagnosed with mild cognitive impairment. Or do you find it harder at times to think, focus or remember the names of people or things.
11. Are you over the age of 65?
12. Do you have difficulty sleeping at night? Or get less than 7 hrs sleep a night?
13. Do you nap more often or longer than you used to during the day?
14. Do you have high blood pressure, atherosclerosis, heart disease or coronary artery disease? Or have you had a TIA, stroke, or a family history of any of these?
15. Is your HDL (good cholesterol) low - below 50 mg/dl?
16. Are you on a medication for cholesterol, i.e. a statin drug?
17. Do you have GERD or acid reflux, or do you take antacids such as Mylanta, Tagamet, Omeprazole (Prilosec), or Zantac on a regular basis?
18. Are you more than 30 pounds (14 kg) overweight?
19. Do you have to urinate more frequently, feel irritable, and/or have a yeast infection? Or has a doctor ever told you that you were diabetic, borderline diabetic, or insulin resistant?
20. Do you often feel cold when others do not, or have you been diagnosed with thyroid problems in the last 10 years?
21. Do you have a history of asthma, emphysema, pneumonia, bronchitis, COPD or any other lung or breathing problems?
22. Do you have Celiac, Crohn’s disease, Colitis, irritable bowel, a leaky gut, or some other digestive disorder?
23. Do you have a history of cold sores or prior exposure to the herpes simplex virus?
24. Do you have any serious infections particularly Chlamydia pneumoniae, influenza, Lyme disease, Candida albicans, listeria, staphylococcus or strep infections
25. Have you ever had head trauma, or been knocked unconscious?
26. Have you ever had gingivitis, periodontal disease bleeding gums, or an infected root canal?
27. Have you experienced a loss of hearing?
28. Do you smoke or vape, or have you done so within the last 10 years?
29. Do you drink 2 or more diet sodas or an alcoholic drink more than three times per week? Or gotten drunk in the past 3 years?
30. Do you live a relatively sedentary lifestyle with little physical activity (less than 15 minutes a day that requires you to breathe harder than normal)?
31. Do you exercise at an intense level for more than 20 minutes 3 or more times per week?
32. Do you NOT enjoy reading or otherwise learning new things?
33. Do you seldom share new information or knowledge with others?
34. Do you crave or have a strong preference for foods high in simple carbs or sugar, such as cookies, cakes, pies, regular chocolate, candy, fruit juice, or ice-cream? (Or eat one or more of these more than 3x per week?)
35. Do you eat more grains (bread, pasta, pie, white rice, etc) than green vegetables, or do you have a gluten sensitivity?
36. Do you eat meat other than fish, such as steak, roasts, lunch meat, hot dogs, hamburgers, smoked meats, Spam (or other foods containing additives), more than once per week?
37. Do you eat deep fried foods - French fries, potato chips, onion rings, fried chicken, more than once a week? Or fry foods in vegetable oils or Crisco?
38. Do you like to eat peanut butter, bread, margarine, salad dressings, snacks foods, baked goods or other foods containing hydrogenated or partially hydrogenated oils or fats?(check the labels)
39. Do you eat Chinese food (or other products containing MSG) more than once a week?
40. Do you NOT eat many berries nor take any good antioxidant supplement like curcumin or vitamin C daily?
41. Have you possibly been exposed to aluminum from baking sodas, deodorants, cookware, or flu vaccines? Or do you drink black tea with lemon?
42. Have you lived, or do you now live in a house constructed before 1978 with lead pipes, or have you otherwise been exposed to lead, as from lead paint, or leaded gas?
43. Do you have old amalgam or silver fillings in your mouth? Or have you lived downwind from a coal burning plant? Consumed large fish Or otherwise been exposed to mercury.
44. Do you drink fluoridated or chlorinated water, or use fluoride toothpaste?
45. Do you take or have you recently taken any of the following medications? An Antacid, Antibiotic, Antihistamine, Diabetes med, Parkinson’s med, estrogen or contraceptive, corticosteroid or other steroid, anti-cholinergic med for bladder control or incontinence.
46. Are you on an Antidepressant, an Anti-anxiety med, Anti-seizure med like Dilantin, a beta blockers for blood pressure, a sleeping pill, sedative, NSAIDS for pain & Inflammation or an antipsychotic med
47. Have you had an operation requiring a general anesthesia in the last 6 years?
48. Do you live or worked in a location that has had mold of any kind?
49. Do you live in a major city, near a busy intersection or some other area where there are high levels of air pollution?
50. Do you live in a new home or have new furniture or carpets that have a flame retardant? Or do you use a disinfectant, hand sanitizer, shampoo, conditioner or fabric softener that contains quaternary ammonium compounds (QACs)? If unsure mark “yes” to learn more about them.
51. Do you use a WiFi or talk on a cell phone for extended periods or sleep with your phone or an electric blanket or clock radio within 3 feet of your head?
52. Have you ever watched a field being sprayed with pesticides, or lived where the house or yard was routinely treated for insects?
53. Have you used the weed killer Round-up, or do you consume a lot of oats or almonds?
54. Are there any smells or chemical compounds that you are sensitive or allergic to?
55. Do you get less than 2 hours of direct sunlight per week, or feel down during the winter months?
Each one of these is a risk factor for cognitive decline; two or more if not addressed suggest a significant risk for eventual memory loss, Alzheimer’s or dementia. See the notes below for tips on where to go and what to do to address each of these factors.
SUBMIT TO SEE SUGGESTIONS
