Memory Decline Questionnaire

Please complete this confidential questionnaire in relation to your close friend or family member who is interested in taking part in research. You have been nominated as a key person to be able to assist us with determining whether this person could have memory decline that is more significant than usual age-related decline. Please provide as much detail as possible.

If you have any questions or issues, please do email us:

If you would like to have a brief overview of the difference between age-related memory decline and Mild Cognitive Impairment (a medical diagnosis from a GP, hospital doctor or a memory clinic), please have a look at the link below:

Mild Cognitive Impairment and Age-related Memory Decline


Please complete the form here: