3. Incorrect by >1 day 7. Don't know 8. No answer 9. Not Q24 Month 1. Correct 2. Incorrect by 1 month 3. Incorrect by >1 month 7. Don't know 8. No answer 9. Not asked Rate as correct if the subject claims it is the previous month in the first week of the month (e.g. March in the first week of April). Q25 Year 1. Correct 2. Incorrect by 1 year 3. Incorrect by >1 year 7. Don't know 8. No answer 9. Not asked Q26 OBSERVATION. IN AN AIMLESS FASHION. OBJECT IN VIEW AT THE BEGINNING IS NOT REACHED. 0. No 1. Yes 9. Inapplicable If Q1=0, Q3=O, Q17=0. The computer will automatically go into priority mode and skip to Q136 Now I would like to ask some questions about your background. Q27 Does anyone else live here? No Yes Q28 Spouse/Partner No/Yes Q29 Parents ____ Q30 Siblings ____ Q31 Children ____ Q32 Grandchildren ____ Q33 Other relatives ____ Q34 Friends ____ Q35 Others ____ DO NOT ASK IF IN AN INSTITUTION Q27 If the subject does not live on own record the relationship of anyone they live with (eg. Parents including in laws, children including in laws, housekeeper, friend etc.). Only include individuals who are permanent members of the household. If the subject lives in a granny flat this count’s as a complete household if it is self-contained. NB. Part-time members of the household are included if their membership is
Q88 How much do you worry? 0. Not unduly 1. Worries a lot about 1 or 2 things. 2. Is a worrier 3. Both 1 & 2 8. No answer 9. Not asked Q88 The question refers to undue worry as R defines it. Rate only if R regards worrying as a substantial part of his / her behaviour. Q89 Does this worrying bother you a lot? Is it unpleasant? (Can you stop yourself worrying?) Do the thoughts keep coming back? 0. No 1. Yes 8. No answer 9. Not asked Q89 Rate positive only for unpleasant worrying which returns repeatedly or which cannot be stopped. It is not imperative that the worrying be out of proportion to the event but in practice this will often be the case. IF THE RESPONDENT HAS SAID THEY HAVE CHILDREN ASK Q90 OTHERWISE SKIP TO Q92 Q90 Is there anything about your relationship with your children that bothers or upsets you? (If YES: what?) 0. No 1. Yes 8. No answer 9. Not asked Q90 Rate 1 if R seems unusually bothered by the relationship. Q91 Specify what? GENERAL ANXIETY Q92 Do you get frightened? (very anxious) (If YES: has that happened lately?) (What made you feel that way?) 0. No 1. Infrequently 2. Frequently/Persistently 8. No answer 9. Not asked Q92-Q93 All of free floating subjective fear, apprehension and anxiety are rated here including the anxiety which may accompany delusions. Do not confuse anxiety with worry, which is not necessarily accompanied by anxiety nor with depressive mood, nor tension which is experienced physically, e.g. in the muscles. Q93 Have you had attacks of fear or panic when you had to do something about it? (e.g. like running out of the room) or felt you would collapse or lose control of yourself?
0. No 1. Rarely 2. Often/all the time 8. No answer 9. Not asked IF =2 ASK Q100, Otherwise skip to Q101 not rate if the term depression is used to describe a mood which is distinct from clinical depression e.g. boredom. You are not concerned here with minor changes. When depressive mood is very severe it pervades all of the individual's mental activity. one third of older people deny depressive mood but clearly exhibit the other symptoms of depression. If R denies depressive mood it should be 0, but you should be vigilant for other signs of depression, especially evidence of depression on observation, and rate these later, if present. You must avoid assuming that because R is of an advanced age or is suffering from severe physical illness, that when depression is expressed it is a normal phenomenon. Such depression should be rated on the value of the mood itself and not its association with age or illness. Depression must not be confused with nervous tension nor anxiety which may, however, coexist. Q100 Have you felt like this continuously for the last two weeks. 0. No 1. Yes Q101 Have you cried at all? (How often?) 0. No 1. Infrequently 2. Frequently/Persistently 8. No answer 9. Not asked Q101-Q102 You should rating crying due to some recognised stimulus (e.g. receiving distressing news where the reaction seems to be reasonable) but rate positively if such a reaction is a change from usual behaviour. Rate 1 if crying occurs several times a week, Rate 2 if it occurs nearly every day or more frequently. IF Q101 = 2 SKIP TO Q103
9. Not asked *Q138 Have you tended to forget things recently? 0. No 1. Yes, several times a week 2. Yes, at least daily 8. No answer 9. Not Q138 For this and the next two questions, rate only problems. DO NOT rate transient mistakes, A RATING of 1 implies it causes difficulty several times a week. A RATING of 2 relates to the frequency of the difficulty IF RATED 1 or 2 ask Q139 OTHERWISE SKIP TO Q141 *Q139 What kinds of things? Names of family and close friends? 0. No 1. Yes, several times a week 2. Yes, at daily 8. No answer 9. Not asked Q139 This concerns family and friends, not persons only met occasionally *Q140 What where you have put things? 0. No 1. Yes, several times a week 2. Yes, at daily 8. No answer 9. Not asked Q140 To rate here means that the subject suffers some degree of inconvenience *Q141 Have you ever been in your own neighbourhood and forgotten your way? 0. No 1. Yes 8. No answer 9. Not asked *Q142 Do you have to make more effort to remember things than you used to? 0. No 1. Yes 8. No answer 9. Not Q142 Rate as present only if this is a constant problem which the subject has to overcome by some strategy IF YES ASK Q143, OTHERWISE SKIP TO Q145 *Q143 When did you first notice this beginning?
Q175 Have you actually been sitting around a lot (or spending more time in bed than usual) because of lack of energy? 0. No 1. Infrequently 2. Frequently/Persistently 8. No answer 9. Not Q175 Rate only if the lack of energy etc is associated with the marked lack of physical activity referred to i.e. sits or lies around because of lack of energy. Do not ask if the respondent is or bedfast just rate 9. 176 OBSERVATION VERY SLOW IN ALL MOVEMENTS. 0. No 1. Mild 2. Severe 9. Not applicable 176 Rate only if all R's movements are slow. Do not rate if obviously due to physical illness, stroke etc. This sign of retardation is present in certain types of depression and in some other psychiatric conditions. TENSION Q177 Do you get worn out (exhausted)? (IF NO:) What about towards the evening? 0. No 1. Mild 2. Severe 8. No answer 9. Not asked In this section rate for a sensation that is unpleasant, that cannot be overcome and is out of proportion to the prevailing circumstances. Q177 Rate only tiredness that is not readily explained by strenuous activities. Q178 Do you have difficulty in relaxing (resting)? 0. No 1. Infrequently 2. Frequently/Persistently 8. No answer 9. Not asked Q178 This refers to relaxing physically. As in symptoms, it must present a problem for the respondent in the last month. Q179 Do you have headaches? 0. No 1. Infrequently 2. Frequently/Persistently 8. No answer 9. Not asked Q179 Include here any headaches.
IF RATED 1 OR 2 ASK Q180 OTHERWISE SKIP TO Q181 Q180 Where? What are they like? (How often)? RATE FOR TENSION HEADACHES. 0. No 1. Mild 2. Severe 8. No answer 9. Not asked Q180 Tension headaches are rated here. These are usually expressed as bands around the head, pressure, tension in the back of the neck or tightness, or pressure upon the top of the head. They are not localised to one side of the head as in migraine and they are not accompanied by visual disturbances or nausea. They are not usually made worse by leaning forward or by rapid movement of the head. In addition, tenderness is sometimes complained of in these areas, especially to the touch of a comb. CEREBROVASCULAR FUNCTION Q181 Do you often feel dizzy? 0. No or rarely 1. More than once per week 8. No answer 9. Not Q182 Do you have a tendency to fall? 0. No or rarely 1. More than once per month 8. No answer 9. Not asked Q183 Have you ever suffered from attacks of dizziness in which things seem to spin around you? 0. No 1. Yes within the last year 2. Yes, more than 1 year ago Q184 Have you ever suffered from... unsteadiness, light headedness or feeling faint? 0. No
Q214 Does the possibility (prospect) of being alone (by yourself) in the future worry you? 0. No 1. Yes 8. No answer 9. Not Q214 Rate if R worries about being alone in the future and these worries are particularly unpleasant. If R is already alone rate the worry about continuing to be alone. 215 Proxy answered eating habits and sleep section. 1. Subject 2. Proxy PERSECUTION Q216 How do you get on with people generally? Do they make you feel ill at ease? 0. No 1. Mildly 2. Severely 8. No answer 9. Not asked Q217 Do you sometimes get the feeling that people are laughing at you, or talking about you? 0. No 1. Infrequently 2. Frequently/Persistently 8. No answer 9. Not asked IF RATED 1 OR 2 ASK Q218, OTHERWISE ASK Q219 Q218 Do you think it really is true, or is it perhaps just the way you feel about it? (Are you sure?) 0. Probably not true 1. Considers it is true 2. Convinced it is true 8. No answer 9. Not asked Q218 In this item only morbid exaggeration of self-consciousness is rated. Rate O if R cannot help feeling that people are taking notice, criticising etc. but knows that it is probably not so. Rate 1 if R is willing to consider it is probably true but does not insist on its truth. Such a degree of conviction is not necessarily out of proportion to R's circumstances. Do not rate if R is eccentrically dressed or behaves strangely,
0. Incorrect 1. Correct 9. Not asked PRAXIS *Q331 Please would you copy this design. OFFER DRAWING SHEET PENTAGON 0. Incorrect 1. Correct 9. Not asked Each pentagon should have 5 clear sides and 5 clear corners and overlap should form a diamond. Q332 And now this design – SPIRAL 0. Incorrect 1. Correct 9. Not Q332 Three connected loops are required in the correct orientation. Q333 And now this – 3D HOUSE 0. Incorrect 1. Correct 9. Not Q333 Requires windows, door, and chimney in correct position and in 3D representation with all angles. Smoke may be omitted. Q334 Draw a large clock face and put all the numbers in. A. Face 0. Incorrect 1. Correct (circle or square) 9. Not asked Q334 ‘Large’ is important; to enable all the numbers to fit in. Square or round is acceptable. If the only numbers marked are for each quarter of an hour, prompt for all numbers. Q335 All numbers 0. Incorrect 1. Correct 9. Not Numbers may be in (I,II,III…) or Arabic (1,2,3…) style Q336 Now set the hands to ten past eleven. 0. Incorrect 1. Correct 9. Not asked *Q337 Write a complete sentence on this sheet of paper. 0. Incorrect 1. Correct Q337 Indicate the bottom of the drawing sheet. Ask the respondent what s/he has written and transcribe it underneath if it is illegible. Spelling and grammar are not important. The sentence must have a