PREVALENCE SCREEN

Thank you for agreeing to be interviewed.  As we explained in our letter, we are collecting information on the changes that occur as people get older.

 

Many of the questions I would like to ask concern your general health and your day-to day activities.  Any information you provide will be treated in the strictest confidence.

Q1-Q10: ORIENTATION SECTION

The aim of this section is to establish the presence of cognitive impairment which will lead to errors in the reply to factual questions.  They concern simple facts about the subject and their orientation.

 

There should be no difficulty in rating the questions in this section.  Do not explore inconsistencies (except age and birth date) but simply rate from the subject's reply.

Q1  First I would like you to remember my name.  My name is …………. Can you repeat that?

 

0.        Unable to repeat

1.        Correctly repeated

2.         

Q1  Give only one name, either the first of the last, choosing the shortest and easiest to pronounce.  Reiterate up to three times as necessary.  Do not exceed three repetitions.

Now I'd like to check that my information about you is correct.

PROMPT ONLY AS INSTRUCTED EXCESSIVE REPETITION IS NOT RECOMMENDED

 

Q2   What is your full name?

0.         Incorrect

1.     Correct 

 

.

IF THE SUBJECT IS LIVING IN AN INSTITUTION ASK Q3, IF NOT SKIP TO Q4.  PROBE FOR FULL ADDRESS

Q2a  A subsidiary question is entered here, on the machine only, to direct the skips.  Answer whether or not the subject is living in an institution.  Residential homes, nursing homes and long stay hospitals count as institutions; a day hospital does not.

Q3    What is the name of this place?  Where is it located.

 

1.         Correct

2.         Error in name

3.         Error in address

4.         Error in name and address

7.         Don't know

8.         No answer

9.         Not asked

 

Q3  Rate 1-Correct, if subject gives only a partial name.

 

       Rate 3-Error in address, if subject only gives locality.

Q4   What is the name of this city/town/village?

 

0.         Incorrect

1.         Correct

7.         Don't know

8.         No answer

9.         Not asked

Q4   A localising answer is required here.  If the subject lives in a remote area, the name of the nearest farm would be considered correct.

 

The answer to this question will be scored either as part of Q3 or Q5

ONLY ASK THIS QUESTION IF THE SUBJECT IS LIVING IN THEIR OWN HOME.  OTHERWISE SKIP TO Q6.  PROBE FOR FULL ADDRESS

 

Q5    What is the full address of this place?

 

0.          Incorrect or incomplete

1.          Correct

7.           Don't know

8.           No answer

9.           Not asked

Q5   The full address is required.  Probe for full address including city, suburb or postal district but not post code.  If in a day hospital ask "What is the postal address of your home?"

Q6    How old are you?

 

0.           Not as listed

1.           As listed

7.          Don't know

8.          No answer

9.          Not asked

 

IF RATING 0, RECORD AGE GIVEN BY SUBJECT.

Q6   The information provided by the FHSA may not be correct.  If the answer provided by the subject is not consistent with your information, record the age given by the subject.

Q7    What is your date of birth?

 

1       As listed

2.           Not as listed, probably correct

3.           Not as listed, probably incorrect

7.           Don't know

8.           No Answer

9.           Not asked.

 

IF RATING 2 OR 3, RECORD DATE OF BIRTH GIVEN BY SUBJECT.

IF DATE OF BIRTH AND AGE ARE INCONSISTENT BY MORE THAN ONE YEAR ASK Q8, IF NOT SKIP TO Q9.

Q7   Again the information provided by the FHSA may not be correct.  If the answer provided by the subject is not consistent with your information, but consistent with the subject's previous answer, (and realistic) rate 2.  If the subject's answers to Q6 and Q7 are inconsistent, rate 3.  If you have rated either 2 or 3, record the date of birth given by the subject.

Q8     That doesn't seem to come out right when I add it up.  Can you help me?

 

0.            Discrepancy not corrected

1.            Discrepancy corrected

2.            Marked uncertainty about age

8.            No answer

9.            Not asked

Q8  Answers 0 and 2 need not be mutually exclusive.  If both are appropriate select answer 2.

Q9     Have you ever seen me before?

 

1.      Correct, No or Yes

2.          Incorrect, No

3.          Incorrect, Yes

8.           No Answer

9.           Not asked.

Q9    In this question you are looking for evidence of pathology.

Rate 1- Correct, either if the subject has or has not seen you before, or if they claim they don not know.  Ratings 2 and 3 are manifestations of pathology.  If the subject claims they have not seen you before and you know they have, probe with "Could you try to remember?"  If they incorrectly believe they have seen you before continue to Q10.

IF YES OR UNCERTAIN PROMPT FOR DETAILS

 

Q10  When?   Where?   What was I doing?  What did we do?

RATE PRESENCE OF CONFABULATION.

 

0.           No confabulation

1.           Confabulation

 

Q10   In this question you are looking for evidence of confabulation.  This means the subject can be led to give an elaborate description of events which clearly could not have occured (not delusional i.e. a whole frame work or mind set, nor misidentification).

 

If the subject has given incorrect answers for 3 or more of the previous questions (Q1-Q9) the machine will automatically skip to Q108-Q116, and thence to Q159.

If using a paper schedule, make the calculation and then skip these sections if necessary.

Now I'd like to ask you some questions about your background.

 

Q11     Are you married, single, widowed or divorced?  (If NO are you separated or do you have a partner?)

 

1        Married

2.           Cohabiting

3.           Single

4.           Widowed

5.           Divorced/Separated

 

 

 

Q11    For multiple marriages code current status.

ITEM 12     Establish type of accommodation.

 

1.           House/Flat/Granny flat

2.       Warden Controlled flat

3.            Council Residential home

4.            Private Residential home

5.            Private Nursing Home

6.            Long stay hospital

7.            Not established

 

IF THE ANSWER TO Q12 IS 3,4,5 OR 6 SKIP TO Q15

ITEM 12    Bungalow - rate as house.  Rate 3 for Part III Accommodation.  If the respondent is in an Elderly Mentally Infirm Unit within an institution rate as for the institution.

Q13  Is this house/flat owned or rented?


1. Owned

2. Council rented
3. Private rented
8
. No answer

Q13 In order to rate 1 it is necessary that no rent is paid on the property.  It may be owned by the subject, a member of the household in which the subject lives or a member of the subject’s family who does not live in the property.  Housing association property is classed as council rented.

Q14   Does anyone else live here?

 

  1. No
  2. Yes

Spouse/Partner                     No/Yes

Parents                                   nn

Siblings                                  nn

Children                                 nn

Grandchildren                       nn

Other relatives                      nn

Friends                                   nn

Others                                    nn

Q14 If the subject does not live on their 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 counts as a complete household if it is self-contained.  NB.  Part-time members of the household are included if their membership is permanent (eg. The child who stays during the week but is away every weekend).

Q15  How long have you lived in (the area)?

 

Answer in years                   nn

777 Don’t know

Q15 This questionis included to elicit information on migration.  Rate the number of years the subject has lived within the locality.  Rate for latest period only if the subject has returned to the area.  Rate 1 year for 1 year or less.

Q15i  What was your previous address?

 

Textual Answer

Q15i  Answer of the form Village, Town, County.

Q15ii  How long did you live there?

 

Nn years

777 Don’t know

Q15ii  Answer to the nearest year

Q15a  Where were you born

 

Textual answer

Q15a Answer of the form – Town, Country, eg. Liverpool, England.  If the answer has already been given in Q15 do not ask again. 

Q15aa  Were either of your parents born in Gwynedd?

 

0.            No

1.            Yes, one or both

2.            Don’t know

3.            No answer

4.            Not asked

 

If any doubt about change of County boundaries, write on contact sheet for coding later.

Q15b  What ethnic group do you consider you belong to?  Are you…(supply likely options)

Q15b  Rate this answer by observation if it is obvious.  Otherwise ask the question.

Q15cc  Do you speak Welsh? (If YES how fluent would you say you are?)

 

0.             Not Welsh speaking

1.            Speaks a little

2.            Fairly fluent

3.            Fully fluent

4.            No answer

8.            Not asked

 

Don’t ask if opted to do interview in Welsh and rate fully fluent.

Q16  How many years did you spend in full-time education?

 

Answer in years   nn

77  Don’t know

Q16  Most people will have had either 8 or 9 years at school, with a starting age of 5 or 6 and a leaving age of 13 or 14.  Include years in full-time higher education.

Q17  Have you retired?

 

0.  No

1.  Yes

2.  Never worked

Q17  The information required here is whether the subject has retired from their major paid employment.  Count as retired someone who has retired from full-time but taken on part-time work.

IF NO SKIP TO Q19.  IF NEVER WORKED SKIP TO Q24.

 

Q18  At what age did you retire?

 

Answer in years   nn

777  Don’t know

 

Q19  What has been your main occupation for most of your working life?

 

Textual answer

Q19  Complete for the occupation that was held for the longest period, even if it is not the most recent.  Give a detailed job title.

Q20  What type of work was/is this?

 

Textual answer

Q20  Answer should include a description of the work and a description of the employer.  This information is required to code both social class and socio-economic group and it is important that sufficient information is collected.  For example:  a carpenter in the building industry would be coded differently from a carpenter in a biscuit factory.

Q21  Were/are you self employed?

 

0.  No

1.  Yes

 

IF YES SKIP TO Q23

 

Q22  Were/are you a foreman, supervisor or manager?  (If Yes, what did you do?)

 

0.  No

1.  Foreman/Supervisor

2.  Manager

 

IF NO SKIP TO Q24

 

Q23  How many employees were/are you responsible for?

 

1.  Less than 25

2.  25 or more

 

QUESTIONS 24-30 SHOULD ONLY BE ASKED OF MARRIED, DIVORCED, SEPARATED OR WIDOWED WOMEN

 

Q24  Is your husband retired?  (Did your husband retire?)

 

0. No

1.  Yes

2.  Never worked

7.  Don’t know

Q24  For multiple marriages code for current/last husband

Q25  At what age did your husband retire?

 

Age in years         nn

777  Don’t know

999  Not asked

 

Q26  What has been/was your husband’s main occupation for most of his working life?

 

Textual answer

Q26  Complete for the occupation that was held for the longest period, even if it is not the most recent.

 

Q27  What type of work was/is this?

 

Textual answer

Q27  Answer should include a description of the work plus a description of the employer.

Q28  Was/is he self employed?

 

0.  No

1.  Yes

7.  Don’t know

9.  Not asked

 

IF YES SKIP TO Q30

 

Q29  Was/is your husband a foreman, supervisor or manager?  (If yes, what did he do?)

 

0.  No

1.  Foreman/Supervisor

2.  Manager

7.  Don’t know

9.  Not asked

 

IF NO SKIP TO Q31

 

Q30  How many employees was/is he responsible for?

 

1.  Less than 25

2.  25 or more

7.  Don’t know

9.  Not asked

 

This next set of question is about your social contacts and social activities

In this following section rate 1 – regularly for daily, weekly, monthly or predictably.  Rate 2 – occasionally if unpredictable, or regularly less than monthly.  For less than yearly, rate 0.

QN1  Do you attend religious meetings?

 

0.  No

1.  Yes, regularly

2.  Yes, occasionally

8.  No answer

9.  Not asked

 

QN2  Do you attend meetings of any community or church or social groups, such as over 60’s clubs, evening classes or anything like that?

 

0.  No

1.  Yes, regularly

2.  Yes, occasionally

8.  No answer

9.  Not asked

 

QN3  How far away does your nearest (in terms of distance) child or other relative live?

0.  No relatives

1.  Within 1 mile/same home

2.  1-5 miles

3.  6-15 miles

4.  16-50 miles

5.  60+ miles

8.  No answer

9.  Not asked

 

IF NO RELATIVES SKIP TO QN12

 

QN4  Do you have any children of your own?

 

0.  No

1.  Yes

7.  Don’t know

8.  No answer

9.  Not asked

QN4  Rate as 1: Yes if stubject volunteers that they have ever had children.  Include adopted children.

QN5  How many children?

 

nn Number of living children

77 Don’t know

99 Not asked

 

QN6  Number of children not living (if volunteered)

nn  Number of dead children

77  Don’t know

99  Not asked

 

QN7  Where does your nearest (in terms of distance) child live?

 

1.  Within 1 mile/same home

2.  1-5 miles

3.  6-15 miles

4.  16-50 miles

5.  60+ miles

8.  No answer

9.  Not asked

 

QN8  Do you have any living sisters or brothers?  (If  Yes, where does your nearest sister or brother live?)

 

0.  No sisters or brothers

1.  Within 1 mile/same home

2.  1-5 miles

3.  6-15 miles

4.  16-50 miles

5.  60+ miles

8.  No answer

9.  Not asked

 

QN9  How often do you see any of your (children or other) relatives to speak to?

 

0.  Never

1.  Daily

2.  2-3 times a week

3.  At least weekly

4.  At least monthly

5.  Less often

8.  No answer

9.  Not asked

QN9  Here you must rate cumulative contact – if the subject sees a different relative every day rate as 1 – daily contact.

QN10  Of all your (children or other) relatives which one do you have the most contact with?

 

A.  Daughter

B.  Son

C.  Daughter-in-law

D.  Son-in-law

E.   Parent

F.  Sister/Brother

G.  Other female relative

H.  Other male relative

X.  Don’t know

Z.  Not asked

Qn10  If subject claims to see two people equally prompt to establish which one they have the most contact with.  Step relative to be rates as ‘other male’ or ‘other famale relative’.

QN11  How often do you see her/him to talk to?

 

1.  Daily

2.  2-3 times a week

3.  At least weekly

4.  At least monthly

5.  Less often

8.  No answer

9.  Not asked

QN11 Rate face to face contact only not telephone calls.

QN12  Do you have friends in this community?  (If Yes how often do you have a chat or do something with one of your friends?)

 

0.  No friends/Never

1.  Daily

2.  2-3 times a week

3.  At least weekly

4.  At least monthly

5.  Less often

8.  No answer

9.  Not asked

Qn12  Rate ‘face to face’ rather than telephone calls.

IF SUBJECT IS IN A NURSING HOME OR LONG STAY HOSPITAL ETC SKIP TO Q39

 

QN13  How often do you see any of your neighbours to have a chat or do something with?

 

0.  No neighbours/Never

1.  Daily

2.  2-3 times a week

3.  At least weekly

4.  At least monthly

5.  Less often

8.  No answer

9.  Not asked

 

Q39  In general, do you get out and about as much as you would like to?

 

0.  No

1.  Yes

8.  Don’t know

9.  Not asked

 

Now I’m going to ask you some questions about your general health

 

Q40  Would you say that for someone of your age, your own health in general is:

 

0.  Excellent

1.  Good

2.  Fair

3.  Poor

8.  Don’t know

9.  Not asked

 

Q41  Have you ever suffered with angina.

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q41  Rate here if the subject has been diagnosed by a doctor as suffering with angina.  If answer is No enter the skip section.

IF YES SKIP TO Q51

 

Q42  Have you ever had any pain or discomfort in the chest?

Q42-50  These 9 questions seek to elicit symptoms of angina from subjects who have not been diagnosed.  Indications contrary to a diagnosis of angina cause a skip to the next section.

IF YES SKIP TO Q44

 

Q43  Have you ever had any pressure of heaviness in your chest?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF BOTH THIS AND THE PREVIOUS QUESTION WERE ANSWERED NO SKIP TO Q51

 

Q44  Do you get it when you walk uphill or hurry?

 

0.  No

1.  Yes

2.  Never hurries or walks uphill

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q51

 

Q45  Do you get it when you walk at an ordinary pace on the level?

 

0.  No

1.  Yes

2.  Never walks

8.  No answer

9.  Not asked

 

IF 2 SKIP TO Q51

 

Q46  What do you do if you get it while you are walking?

 

1.  Stop or slow down

2.  Carry on

8.  No answer

9.  Not asked

Q46  Record stop or slow down if subject carries on after taking nitroglycerine.

Q47  If you stand still what happens to it?

 

0.  Not relieved

1.  Relieved

8.  No answer

9.  Not asked

 

Q48  How soon?

 

1.  10 minutes or less

2.  More than 10 minutes

8.  No answer

9.  Not asked

 

IF MORE THAN 10 MINUTES SKIP TO Q51

 

Q49  Will you show me where it was?  (PROMPT:  Anywhere else?)

 

a)  Above/in the centre of the breast bone

b)  Under the breast bone

c)  Left front of the chest

d)  Left arm

e)  Other

 

Q50  Did you see a doctor because of this pain (discomfort?)

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

Q51  Have you ever suffered from intermittent claudication?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q51  Rate here if a doctor has made a diagnosis for intermittent claudication.  If subject’s answer is No, or they don’t know, go into the skip section

IF YES SKIP TO Q61

 

Q52  Do you get pain in either leg on walking?

 

0.  No

1.  Yes

2.  Chair/Bedfast

8.  No answer

9.  Not asked

Q52-Q60  These 9 questions are designed to elicit information for a diagnosis of intermittent claudication in the absence of the subject’s knowledge.  Contra indications to the diagnosis cause a skip to the next section.

IF NO OR CHAIR/BEDFAST SKIP TO Q61

 

Q53  Does this pain ever begin when you are standing still or sitting?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF YES SKIP TO Q61

 

Q54  In what part of your leg do you feel it?

 

0.  Not in calf or calves

1.  In calf or calves

8.  No answer

9.  Not asked

 

IF CALVES NOT MENTIONED, ASK:  Anywhere else?

IF NOT IN CALVES SKIP TO Q61

 

Q55  Do you get it if you walk uphill or hurry?

 

0.  No

1.  Yes

2.  Never hurries or walks uphill

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q61

 

Q56  Do you get it if you walk at an ordinary pace on the level?

 

0.  No

1.  Yes

2.  Never walks

8.  No answer

9.  Not asked

 

IF YES SKIP TO Q61

 

Q58  What do you do if you get it when you are walking?

 

1.  Stop or slow down

2.  Carry on

8.  No answer

9.  Not asked

 

Q59  What happens to it if you stand still?

 

0.  Not relieved

1.  Relieved

8.  No answer

9.  Not asked

 

Q60  How soon?

 

1.  10 minutes or less

2.  More than 10 minutes

8.  No answer

9.  Not asked

 

IF NOT RELIEVED SKIP TO Q61

 

Q61  Have you ever suffered from a heart attack?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q66

 

Q62  How many heart attacks have you had?

 

Number of attacks                nn

88  No answer

99  Not asked

 

Q63  Who diagnosed this/these heart attack(s)?

 

0.  No doctor

1.  GP

2.  Specialist

8.  No answer

9.  Not asked

Q63  If diagnosed y more than one person rate for the most specialised, e.g. if diagnosed by both a GP and a Specialist, code as specialist.  If seen at a hospital, rate as specialist.

Q64  How old were you when you had the (first) attack?

Age in years         nnn

777  Don’t know

888  No answer

999  Not asked

 

Q65  How old were you when you had the last attack?

 

Age in years         nnn

777  Don’t know

888  No answer

999  Not asked

 

Q66  Have you ever been told that you have high blood pressure?

 

0.  No

1.  Yes, by GP

2.  Yes, by other

8.  No answer

9.  Not asked

Q66  Exclude high blood pressure in pregnancy.

IF NO SKIP TO Q69  

Q67 Were you given medicine for high blood pressure?

0.  No
1.  Yes, by GP
2.  Yes, by specialist
8.  No answer

9.  Not asked
Q67  Rate 2 if given medicine by anyone at the hospital.
IF NO SKIP TO Q69  

Q68  How long did you take/have you been taking this medicine?

 

Length of time      yy.mm

77.77   Don’t know

88.88   No answer

99.99  Not asked

Q68  Note in years and months.

Q69  Have you ever had a stroke that required medical attention?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q69  Record only episodes that lasted for 48 hours or longer with partial paralysis in left or right arm and/or leg, blindness in eye/s, or speech disturbance.  Ensure that respondent doesn’t mean a heart attack.  Rate No if the respondent does not know or cannot remember.  Paralysis on the right hand side of the face may be associated with speech difficulty.

IF NO SKIP TO Q74

 

Q70  How many have you had?

 

Number of strokes               nn

77  Don’t know

88  No answer

99  Not asked

 

Q71  How old were you when you had the (first) stroke?

 

Age in years         nnn

777  Don’t know

888  No answer

999  Not asked

 

Q72  How old were you when you had the last stroke?

 

Age in years         nnn

777  Don’t know

888  No answer

999  Not asked

 

Q73  Who diagnosed the stroke/these strokes?

 

0.  No doctor

1.  GP

2.  Specialist

8.  No answer

9.  Not asked

Q73  If diagnosed by more than one person rate for the most specialised e.g. if diagnosed by both a GP and a specialist code for specialist.  Rate specialist if ever attended hospital.

Q74  Have you ever experienced sudden problems with your speech WHICH GOT BETTER AFTER A DAY?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q74  Include unclear speech, not being able to pronounce words that are definitely known and not forming the correct sound.  Episodes to last less than 24 hours.

Q75  Have you ever experienced problems with your sight WHICH GOT BETTER AFTER A DAY?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q75  Include double vision, no vision, black in front of one/both eyes or something in vision (such as a beam, line or spot).  Episodes to last less than 24 hours.

Q76  Have you ever experienced a sudden weakness in an arm or leg WHICH GOT BETTER AFTER A DAY?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q80

 

Q77  Have you ever had sugar diabetes?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q80

 

Q78  How old were you when diabetes was first diagnosed?

 

Age in years         nnn

777  Don’t know

888  No answer

999  Not asked

 

Q79  Are you currently being treated for your diabetes? (If YES what sort of treatment?)

 

0.  No

1.  Yes, dietary control only

2.  Yes, injections

3.  Yes, tablets

4.  Yes, both

8.  No answer

9.  Not asked

 

Q80  Have you ever had fits or epilepsy?

 

0.  No

1.  Only 1 known fit

2.  More than 1 fit

8.  No answer

9.  Not asked

 

Q81  Have you ever had a serious head injury and been unconscious after it?  (Have you ever been knocked out?)

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q85

 

Q82  How many times?

 

Number of times   nn

77  Don’t know

88  No answer

99  Not asked

Q82  If number is greater than 3, answer Q83 and Q84 for the longest three incidents.

Q83  How old were you?

 

Age incident 1

Age incident 2

Age incident 3

Q83  Record age in years.  Rate 777 Don’t know; 888 No answer;  999 Not asked.

Q84  How long were you unconscious?

 

Incident 1              dd.hh.mm

Incident 2              dd.hh.mm

Incident 3              dd.hh.mm

Q84  Record days, hours and minutes.  If longer than 100 days, record 66.66.66;  77.77.77 for Don’t know; 88.88.88 for No answer and 99.99.99 for Not asked.

ASK MEN ONLY

 

Q85  Did you ever box when you were younger?

 

0.  No

1.  Yes, up to age 18

2.  Yes, over 18

 

Q86  Have you ever had a general anaesthetic?  (If NO: have you ever had a major operation?)

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q88

 

Q87  How many times?

 

Number of times

Q87  Rate 77 for Don’t know;  88 for No answer;  99 for Not asked.

Q88  Have you ever consulted a doctor about emotional problems, or problems with your nerves?  Perhaps if you were depressed or anxious, or found that you couldn’t enjoy yourself?

 

0.  No

1.  Yes, sounds like depression

2.  Yes, sounds like anxiety

3.  Yes, other

8.  No answer

9.  Not asked

Q88  Depression:  Feeling low in mood, no sleep, loss of weight, not able to get things done.  Anxiety:  Feelings of impending panic.

IF NO SKIP TO Q94

 

Q89  How old were you when you first saw a doctor about that?

 

Age in years

Q89  Rate 777 for Don’t know; 888 for No answer; 999 for Not asked.

Q90  What did the doctor say you had?

 

1.  Depression

2.  Manic depression

3.  Other/non-specific

8.  No answer

9.  Not asked

 

Q91  Did your GP arrange for you to see a specialist?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

Q92  Did you go into hospital?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

Q93  How was the problem treated?

 

1.  Drugs

2.  ECT

3.  Both

4.  Other

8.  No answer

9.  Not asked

 

Q94  Do you suffer from regular headaches?

 

0.  No

1.  Yes, non specific

2.  Yes, migraine

8.  No answer

9.  Not asked

 

Q95  Do you suffer from hearing problems which interfere with day-to-day living?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q95  If hearing is not problematic because the subject uses an aid then rate 0.

Q96  Do you suffer from poor eyesight which interferes with day-to-day living?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q96  To count as poor eyesight must interfere even when wearing glasses.  If subject wears glasses all the time or in certain conditions but otherwise reports no problems, rate 0.

Q97  Have you ever suffered from asthma?

 

0.  No

1.  Yes, childhood only

2.  Yes

8.  No answer

9.  Not asked

 

Q98  Have you ever suffered from arthritis?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q98  Rate for arthritis in any part of the body.  Include persistent joint pain.

Q99  Have you ever suffered with chronic bronchitis?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

Q100  Have you ever suffered from thyroid problems?

 

0.  No

1.  Underactive current

2.  Overactive current

3.  Other/non-specific current

4.  Underactive past

5.  Overactive past

6.  Other/non specific past

8.  No answer

9.  Not asked

 

Q101  Have you ever suffered from peptic ulcers?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q101  Rate for both gastric and duodenal ulcers.

Q102  Have you ever suffered with pernicious anaemia?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

Q103  Have you ever suffered from meningitis or encephalitis (brain fever)?

 

0.  No

1.  Yes, meningitis

2.  Yes, encephalitis

3.  Yes, non specific

8.  No answer

9.  Not asked

 

Q104  Have you ever suffered from shingles?  (If YES, Where?) (If HEAD NOT MENTIONED: Anywhere else?)

 

0.  No

1.  Yes, in the body

2.  Yes, in the head

8.  No answer

9.  Not asked

Q104  The location of shingles is important here.  Shingles in the trunk is less significant than shingles in the head.  Rate in the head for shingles on the face, in the eyes, in the ears or on the scalp.

A105  Have you ever been diagnosed as having Parkinson’s disease?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

ASK WOMEN ONLY

 

Q105a  How old were you when you had your last menstrual period?

 

Answer in years   nn

77  Not known

88  No answer

99  Not asked

00  Still menstruating

Q105  Age of menopause is thought to be a risk factor for vascular dementia.  Age of last menstrual period is asked because it is more specific and therefore easier to pinpoint.  Try to complete even if only an approximation.  Answer with age of last period even if it was brought forward by hysterectomy or extended by HRT.

This next set of questions is about your first degree blood relatives, that is, your parents, brothers and sisters, or children.

 

Q106  How many of them have ever suffered from the following disorders:

 

Down’s syndrome (What used to be known as a Mongol child)      nn

Senility/dementia/serious memory problems   nn

Alzheimer’s disease                                             nn

Parkinson’s disease                                             nn

Stroke                                                                     nn

Heart attack                                                           nn

Sugar diabetes                                                      nn

Leukemia/lymphoma                                            nn

Psychiatric disorder                                             nn

Q106  Enter the number of first degree relatives that have ever suffered.  First degree relatives:  parents, brothers, sisters, children, half-brothers and sisters.  Note:  not second degree relatives:  aunts, uncles, cousins.  Rate 77 for Don’t know, 88 for No answer, 99 for Not asked.  If the subject has been adopted and has no information about their blood relatives rate 77.  In each case, if only one relative has been named, ask ‘Anyone else?’

Q107  How old was your mother when you were born?

 

Age in years  nn

88  No answer/not known

99  Not asked

Q107  Maternal age at birth is thought to be a risk factor for dementia.  It is important that we collect this information as accurately as possible.  If the subject cannot remember try to help them calculate this by asking their mother’s year of birth, or even year of death and age at death.  If this still doesn’t help suggest a range and ask S to be more specific.  A relatively inaccurate age is better than no age at all.  Critical ages are with the change in risk:  higher risk age 17-18, lower at 20, lowest at 21-22 rising to age 35.  The greatest risk is at 35 and over.  Rate 88 for No answer or Not known and 99 for Not asked.

RATE:  WHO ANSWERED THIS ‘RISK FACTORS’ SECTION?

 

0.  Subject

1.  Proxy

 

This next section of questions is about your memory and how well you sleep.

 

Q108  Have you ever had any difficulty with your memory?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q110

 

Q109  Was?Is that a problem for you?

 

0.  No

1.  Yes, moderate

2.  Yes, severe

8.  No answer

9.  Not asked

Q109  Rate as a problem if the subject says that it is a problem.

Q110  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 asked

Q110  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.   Likewise a rating of 2 relates to the frequency of the difficulty.

IF NO SKIP TO O113

 

Q111  What kinds of things?  Names of family and close friends?

 

0.  No

1.  Yes, several times a week

2.  Yes, at least daily

8.  No answer

9.  Not asked

Q111  This concerns family and close friends, not persons only met occasionally.

Q112  What about where you have put things?

 

0.  No

1.  Yes, several times a week

2.  Yes, at least daily

8.  No answer

9.  Not asked

Q112  To rate here means that the subject suffers some degree of inconvenience.

Q113  Do you have to make more effort to remember things than you used to?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q113  Rate as present only if this is a constant problem which the subject has to overcome by some strategy.

IF NO SKIP TO Q115

 

Q114  When did you first notice this beginning?

 

1.  Less than 1 year

2.  In the last 1-2 years

3.  In the last 3-4 years

4.  In the last 5-10 years

5.  Over 10 years ago

8.  No answer

9.  Not asked

 

Q115  Do you remember my name?  What is it?

 

0.  Incorrect

1.  Correct

8.  No answer

9.  Not asked

Q115  Allow minor mispronunciations.  If the subject indicates s/he does not know, ask once, ‘Could you try to remember?’  If not known, rate as incorrect.

ITEM 116 – INTERVIEWER RATING

 

IN INTERVIEWER’S OPINION SUBJECT HAS DIFFICULTY WITH THEIR MEMORY.

 

0.  No

1.  Yes, mild to moderate

2.  Yes, severe

9.  Inapplicable

I116  Here you must judge whether there is a genuine difficulty experienced.  Many subjects with depression complain about their memory but in practice it does not really present difficulties in daily living.  Do not rate minor problems with remembering the names of acquaintances.

RATE:  WHO ANSWERED THIS ‘MEMORY’ SECTION

 

0.  Subject

1.  Proxy

 

Q117  Do you ever have any problems sleeping?   (PROMPT:  How often?)

 

0.  Never

1.  Seldom

2.  Sometimes

3.  Often

4.  All the time

8.  No answer

9.  Not asked

Q117  If the subject uses one of the terms on the checklist code as such.  Otherwise, using prompts, code appropriately.  For example:  every night, always (All the time);  most nights, at least two or three times a week, usually (Often);  a recognisable problem at least once a month (Sometimes);  hardly ever, very rarely, not more than once a month (Seldom).  If subject takes sleeping pills rate according to their answer e.g. No, because I take tablets, rate 0.  Sleeping problems caused by snoring spouses traffic noise etc. are sleeping problems.

IF NEVER OR SELDOM SKIP TO Q120

 

Q118  Do you have problems staying asleep or falling asleep?

 

1.  Staying asleep

2.  Falling asleep

3.  Both

8.  No answer

9.  Not asked

Q118  Rate 1 if the subject has repeated awakenings during the nights and has trouble getting back to sleep.  Rate 2 if the subject spends a long time trying to get to sleep.

Q119  At what age did your sleep become a problem?

 

Age in years      nnn

777  Don’t know

888  No answer

999  Not asked

 

Q120  Do you snore? 

(PROMPT:  How often?)

 

0.  No

1.  Sometimes

2.  All the time

7.  GENUINELY doesn’t know

8.  No answer

9.  Not asked

Q120  Code as for Q117.  Code regularly as all the time.

I would now like to ask you questions about day to day activities which some people find difficult. 

Some of these questions are relevant to your GP.  Do you have any objections if I pass on the answers?

The following 9 questions (Q121-Q129) take the same form and these notes should be applied consistently throughout.  It will be necessary to probe in order to confirm the use of aids in carrying out activities of daily living.  Using scissors as an aid to cut toe nails does not count as we would all normally use these.  However, specially adapted furniture or the use of adapted cooking utensils would count as special aids.

Q121  I would like to know if you are able, or if you have any difficulty with, the following activities.  Are you able to cut your own toe nails?  (If YES:  Do you have difficulty?)

 

0.  (No), needs help

1.  (Yes), some difficulty

2.  (Yes), no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

Probing will also be necessary to establish whether the subject would be able to undertake the activity in the absence of another person.  This particularly applies to men when asking about household activities but it could equally apply to women where someone else is available.

Q122  Are you able to wash all over or bath?  (If YES:  Do you have difficulty?)

 

0.  No, needs help

1.  Yes, some difficulty

2.  Yes, no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

People with mental frailties who cannot undertake activities because of their mental frailty should be coded as needing help.

Q123  Are you able to get on a bus?  (If YES:  Do you have difficulty?)

 

0.  No, needs help

1.  Yes, some difficulty

2.  Yes, no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

Rate 0 - Needs help if the subject requires assistance from another person to undertake the activity.  Do not use this code if they could undertake the activity for themselves but someone usually does it for them.

Rate 1 -  Some difficulty if the subject reports difficulty undertaking activity or if they report no difficulty but use an aid.  Rate 2 – No difficulty if the subject is able to undertake this activity by themselves without difficulty and without the use of aids or help from others.

Q124  Are you able to go up and down stairs?  (If YES:  Do you have difficulty?)

 

0.  No, needs help

1.  Yes, some difficulty

2.  Yes, no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

 

Q125  Are you able to do heavy housework?  (If YES:  Do  you have difficulty?)

 

0.  No, needs help

1.  Yes, some difficulty

2.  Yes, no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

Q125  Heavy Housework – for example, washing floors.

Q126  Are you able to shop and carry heavy bags?  (If YES: Do you have difficulty?

 

0.  No, needs help

1.  Yes, some difficulty

2.  Yes, no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

 

Q127  Are you able to prepare and cook a hot meal?  (If YES:  Do you have difficulty?)

 

0.  No, needs help

1.  Yes, some difficulty

2.  Yes, no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

Q127  If the subject claims they never have to cook a hot meal because this is always done for them, ask them to make a judgment as to whether they could if they had to.

Q128  Are you able to reach an overhead shelf?  (If YES:  Do you have difficulty?)

 

0.  No, needs help

1.  Yes, some difficulty

2.  Yes, no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

 

Q129  Are you able to tie a good knot in a piece of string?  (If YES:  Do you have difficulty?)

 

0.  No, needs help

1.  Yes, some difficulty

2.  Yes, no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

 

Q130  Are you able to put on your shoes and socks or stockings?  (If YES:  do you have difficulty?)

 

0.  (No), needs help

1.  (Yes), some difficulty

2.  (Yes), no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

 

Q135  Are you able to get to or use the toilet?  (If YES:  do you have difficulty?)

 

0.  No, needs help

1.  Yes, some difficulty

2.  Yes, no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

 

Q144  Are you able to do the light housework?  (If YES:  do you have difficulty?)

 

0.  No, needs help

1.  Yes, some difficulty

2.  Yes, no difficulty

7.  Don’t know

8.  No answer

9.  Not asked

 

Q145  Does anyone help you with any of the day-to-day tasks I’ve just asked about?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q149

 

Q146 Who usually helps?

 

A  No-one

B  Spouse

C  Daughter

D  Daughter-in-law

E  Son

F  Son-in-Law

G  Brother

H  Sister

I  Other relative

J  Friend or neighbour

K  Home help

L  Care worker

M  Meals on wheels

N  Community worker

O Community nurse

P  Warden

Q  Paid help

R  Other (specify)

S   Not applicable

Q146  Code main helper.

IF 00 SKIP TO Q149

 

Q147  Do they help every day, most days or less often?

 

0.  Every day

1.  Most days

2.  Less often

8.  No answer

9.  Not asked

 

Q148  Does anyone else help?

 

A  No-one else

B  Spouse

C  Daughter

D  Daughter-in-law

E  Son

F  Son-in-Law

G  Brother

H  Sister

I  Other relative

J  Friend or neighbour

K  Home help

L  Care worker

M  Meals on wheels

N  Community worker

O Community nurse

P  Warden

Q  Paid help

R  Other (specify)

S   Not applicable

Q148  Code up to three other helpers.

ITEM 149  Establish degree of mobility of subject.

 

1.  Usually ambulant non-housebound

2.  Usually ambulant housebound

3.  Chairfast permanently

4.  Bedfast permanently

7.  Unable to establish mobility

I149  Where subject’s degree of mobility is obvious you may code from observation or from information already obtained.  However check that the observed state is permanent and not temporary i.e. the subject is not expected to improve markedly in the short term.  If in doubt over-estimate degree of disability and notify.

 

Rate 1 -  For people who are usually able to get out without assistance.

Rate 2 -  For people who can get about on the level inside but who never go out of the house or garden without assistance.

Rate 3 - For people who spend all their time confined to a chair or who need help to transfer from the chair to the toilet or bed.  Use this rating for a wheelchair user even if they can get out of the house.

Rate 4 - For people who spend all their time confined to bed.

Now I am going to ask you about smoking and drinking.

 

Q150  Do you smoke?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF NO SKIP Q152

 

Q151  How many cigarettes to you smoke in a day?

 

0.  Cigars/pipe only

1.  Only smoke occasionally

2.  1 – 3

3.  4 – 9

4.  10 – 19

5.  20 – 29

6.  30+

8.  No answer

9.  Not asked

Q151  Record amount currently smoked.

SKIP TO Q155

 

Q152  Have you ever smoked?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q156

 

Q153  How old were you when you stopped?

 

Age in years     nn

Q153  Record subject’s age when they last stopped smoking.  Enter 888 if no answer and 999 if not asked.

Q154  How many cigarettes did you smoke in a day?

 

0.  Cigars/pipe only

1.  Only smoke occasionally

2.  1 – 3

3.  4 – 9

4.  10 – 19

5.  20 – 29

6.  30+

8.  No answer

9.  Not asked

Q154  Record consumption prior to giving up.

Q155  How old were you when you first started smoking? 

 

Age in years     nn

Q144  Record subject’s age when they first started smoking on a regular basis.

Q156  Have you every taken an alcoholic drink of any kind?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q159

 

Q158AA  What is the most you now drink per week on a regular basis?

 

nn  Units beer, lager, shandy

nn  Units wines, sherry, port, vermouth, etc.

nn  Units spirits, liqueurs

 

 

 

AAA  (1 pint beer/lager=2 units;  1 pint shandy=1 unit)

BBB  (1 glass=1 unit)

CCC  (1 pub measure=1 unit)

Q158BB  Has there been any significant change (in your pattern of drinking)?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

 

IF NO SKIP TO Q157BB

 

Q157AA  What is the most you would drink per week on a regular basis before you reached the age of 65?

 

nn  Units beer, lager, shandy

nn  Units wines, sherry, port, vermouth, etc.

nn  Units spirits, liqueurs

 

 

 

(1 pint beer/lager=2 units;  1 pint shandy=1 unit)

(1 glass=1 unit)

(1 pub measure=1 unit)

Q157BB  Has a doctor ever advised you to stop or reduce your drinking for your health’s sake?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q157BB  Don’t ask and code 9 for non-drinkers.

Q157CC  Did anyone – relations, friends, workmates, employer – ever suggest that you should reduce your drinking?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q157CC  Don’t ask and code 9 for non-drinkers.

RATE:  WHO ANSWERED THIS ‘SMOKING & DRINKING SECTION’

 

0.  Subject

1.  Proxy

 

The next part of the interview is concerned with memory and concentration.  Some of the questions may seen rather easy, but others are more difficulty so please listen carefully.  No-one is expected to manage them all so please don’t worry.  If you wear reading glasses you will need them for some of the things I’m going to ask you to do.  First:

This last section forms part of the cognitive examination.  Some of the items (those marked with a star) are part of the Mini Mental State Examination.  If you seem to be losing the subject’s co-operation ask these items as a priority.

 

It is important that you speak slowly and clearly.  If the subject appears not to have heard or understood, repeat the question (unless the item specifically prohibits repetition).

 

DO NOT CORRECT IF A WRONG ANSWER IS GIVEN.

*Q159  What day of the week is it today?

 

0.  Incorrect

1.  Correct

9.  Inapplicable

 

*Q160  What is the date today?

 

Day

1.  Correct

2.  Incorrect by 1 day

3.  Incorrect by >1 day

7.  Don’t know

8.  No answer

9.  Not asked

 

Month

1.  Correct

2.  Incorrect by 1 month

3.  Incorrect by >1 month

7.  Don’t know

8.  No answer

9.  Not asked

 

Year

1.  Correct

2.  Incorrect by 1 year

3.  Incorrect by >1 year

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).

*Q161  What is the season?

 

0.  Incorrect

1.  Correct

9.  Inapplicable

Q161  Allow flexibility when season changes, e.g.:

 

March = winter/spring

June = spring/summer

September = summer/autumn

Late Nov/Dec = autumn/winter

Can you tell me where we are now?   For instance:

 

*Q162  What county are we in?

 

0.  Incorrect

1.  Correct

9.  Inapplicable

 

*Q163  Name two main streets nearby (or near to your home)?

 

0.  Incorrect

1.  Correct

9.  Inapplicable

Q163  Not including their own street.

*Q164  What floor of this building are we on?

 

0.  Incorrect

1.  Correct

9.  Inapplicable

 

ITEM 195  Rate if there are any errors in the orientation (Q1-10) or memory (Q108-155, 160) sections, or if responses to many of the other items were inaudible, inappropriate or incoherent.

 

Errors made in clear consciousness due to agitation, depression or elation.

 

0.  Absent

1.  Agitation

2.  Depression

3.  Elation

9.  Inapplicable

Clear consciousness – i.e. not falling asleep, or under the influence of alcohol or drugs or delirium due to acute physical illness.  The individual will be alert, responsive and focused.  Agitation:  will appear anxious.

Depression:  typified by slow and low mood.

Most people with dementia will make an effort, whilst those who are depressed will emanate negative feelings and not try. 

Elation typified by fast speech and high mood with an inability to concentrate and easily distracted.

Errors made in clear consciousness due to memory defect.

 

0.  Absent

1.  Present

9.  Inapplicable

 

Errors made in clouded consciousness.

 

0.  Absent

1.  Present

9.  Inapplicable

Clouded consciousness – i.e. subject was falling asleep, under the influence of alcohol, drugs or delirium due to acute physical illness.  The individual will be very distractible, unfocused and my drift in and out of consciousness.   Often worse in the evening and afternoon.

Respondent rambles:  talks in an aimless fashion.  Object in view at the beginning is not reached.

 

0.  No

1.  Yes, to some extent

2.  Yes, to a marked extent

9.  Not applicable

 

Reaction to errors was characteristically bland, indifferent or euphoric.

 

0.  Absent

1.  Present

9.  Inapplicable

Euphoria:  overall sense of well being.

SHOW PENCIL

 

*Q166  What is this called?

 

0.  Incorrect

1.  Correct

9.  Inapplicable

Q166 – 169  For these questions accurate naming is required.  Descriptions of function or approximate answers are not acceptable.  For example:  used for telling the time, for wristwatch, would be incorrect.

Present the objects to the subject and allow them to be held.  Put the objects out of sight before proceeding.

SHOW WRISTWATCH

 

*Q167  What is this called?

 

0.  Incorrect

1.  Correct

9.  Inapplicable

 

SHOW KEYS

 

Q168  What are these called?

 

0.  Incorrect

1.  Correct

9.  Inapplicable

 

SHOW ENVELOPE

 

Q169  What is this called?

 

0.  Incorrect

1.  Correct

9.  Inapplicable

 

Later on I’m going to give you a name and address to write on this envelope.  When you have finished doing that I’d like you to do the following:  turn it over, seal it, and write your initials on the back.  Could you remember to do that then, without me reminding you?

Illustrate the actions whilst giving the instructions.

Q170  Now I’d like you to tell me as many different animals as you can think of in one minute.

 

Enter number     nn

88 No answer

99 Not asked

Q170  If subject asks for clarification, explain that animals include birds, insects, humans etc.  if subject gets stuck, encourage with ‘Can you think of any more?’  Record number correct in one minute (repetitions not to be counted).  Enter 88 for No answer and 99 for Not asked.   Pressing any key on the laptop will activate the timer.  Write the list of animals on the paper contact sheet.

I am now going to say something and I would like you to repeat it after me.

 

*ITEM 171  No ifs, and or buts.

 

0.  Incorrect

1.  Correct

9.  Inapplicable

I170  Only one presentation is allowed so it is essential that you read the phrase clearly and slowly, enunciating all the S’s.

Q172  What are the four things I asked you to name a few minutes ago?

 

Pencil

0.  Not recalled

1.  Recalled

9.  Not asked

Q172  Rate as correct if the subject remembers what they said previously, even if it was originally misidentified.  When asking this question gesticulate as though presenting the respondent with the object.

Wristwatch

0.  Not recalled

1.  Recalled

9.  Not asked

 

Keys

0.  Not recalled

1.  Recalled

9.  Not asked

 

Envelope

0.  Not recalled

1.  Recalled

9.  Not asked

 

Q173  Who is the Prime Minister?

 

0.  Incorrect

1.  Correct

9.  Inapplicable

 

Q174  Who is the president of the United States of America?

 

0.  Incorrect

1.  Correct

9.  Inapplicable

 

Q175  What are the colours of the Union Jack?  (Our the national flag)

 

0.  Incorrect

1.  Correct, red, white & blue

9.  Inapplicable

 

Q176  Who was Neville Chamberlain?

 

0.  Incorrect

1.  Correct, A Prime Minister.

9.  Inapplicable

 

Q177 Who was Guy Burgess?

 

0.  Incorrect

1.  Correct, A spy.

9.  Inapplicable

 

*ITEM 178  I am now going to say three words.  After I have finished saying all three, I want you to repeat them.  Remember what they are because I am going to ask you to name them in a few minutes.  NAME THESE 3 OBJECTS TAKING 1 SECOND TO SAY EACH:

 

Apple, Table, Penny

 

Apple

0.  Not named on first try

1.  Named on first try

9.  Not asked

 

Table

0.  Not named on first try

1.  Named on first try

9.  Not asked

 

Penny

0.  Not named on first try

1.  Named on first try

9.  Not asked

If any errors or omissions are made on the first attempt, repeat all the names until subject learns all three up to a maximum of five repeats.

*ITEM 179  Now I would like you to take 7 away from 100.  Now take 7 away from the number you get.

Now keep taking 7 away until I tell you to stop.

 

Record the answers:

nn, nn, nn, nn, nn.

888  No answer

999  Not asked

ITEM 179  Score 1 point for each time the difference is 7, even if a previous answer was incorrect.  Maximum score 5 points.  DO NOT repeat the number you were given.  Enter 888 if No answer given and 999 for Not asked.  An entry of 999 will cause a skip to the next question.

*Q180  What were the three words I asked you to repeat a little while ago?

 

Apple

0.  Not recalled

1.  Recalled

9.  Not asked

 

Table

0.  Not recalled

1.  Recalled

9.  Not asked

 

Penny

0.  Not recalled

1.  Recalled

9.  Not asked

 

 

OFFER SUBJECT THE SENTENCE AT THE END OF THE HANDBOOK (Close your eyes)

 

ITEM 181  Please read what is here and do what it says.

 

0.  Incorrect

1.  Correct

9.  Inapplicable

ITEM 181  It is not necessary for the subject to read aloud.  Score as correct only if the action is correctly carried out.  If the subject reads the instruction but fails to carry out the action, say ‘Now do what it says’.

OFFER SUBJECT THE DRAWING PAGE

 

*ITEM 182  Here is a drawing.  Please copy the drawing on the same paper.

 

0.  Incorrect

1.  Correct

9.  Inapplicable

ITEM 182  Correct if the two five-sided figures intersect to form a four-sided figure and if all the angles in the five-sided figures are preserved.

NB  Copy to be below the original and drawing to be done freehand.  If will not attempt it mark as incorrect.

*ITEM 183  Write a complete sentence on this sheet of paper.

 

0.  Incorrect

1.  Correct

9.  Inapplicable

ITEM 183  Sentence to be written in the box on the same piece of paper as the previous item.  Spelling and grammar are not important.  The sentence must have a subject (real or implied) and a verb.  ‘Help’ or ‘Go away’ are acceptable.  If sentence is illegible ask subject what they have written and write it underneath.  Under no circumstances should you write it for them from dictation.

RATE:  *IS THE SUBJECT LEFT- OR RIGHT-HANDED?

 

1.  Right-handed

2.  Left-handed

3.  Ambidextrous

7.  Unable to judge

 

READ FULL STATEMENT STRESSING THE WORDS IN CAPITALS AND THEN HAND OVER PAPER

 

*ITEM 184  I am now going to give you a piece of paper.  When I do, take the paper in your RIGHT hand.  Fold the paper in HALF with BOTH hands and put the paper down on your LAP.

 

Takes in right hand

0.  Incorrect

1.  Correct

9.  Inapplicable

 

Folds in half

0.  Incorrect

1.  Correct

9.  Inapplicable

 

Places on lap

0.  Incorrect

1.  Correct

9.  Inapplicable

ITEM 184  If the full sequence is not completed repeat the whole instruction to ensure that it has been heard and understood.  Do not prompt.

Score a move as correct only if it takes place in the correct sequence.  Modify instruction for one-handed subjects.  If one-handed score “Takes in right hand” as 9.

GIVE THE ENVELOPE TO THE SUBJECT

 

ITEM 185  Please write the following name and address on this envelope:

 

John Brown

42 West Street

Bedford.

 

0.  Incorrect

1.  Poor but acceptable

2.  Correct

9.  Not asked

ITEM 185  Dictate the name and address slowly enough for the subject to be able to write from your dictation.  Spelling and neatness are not important.  The criterion by which you should judge the subject’s response is whether the letter is likely to reach the exact destination.  So, Jon Brwn is acceptable, 24 and ‘Burford’ are not.

 

If the subject is unable to write, say the address slowly twice and ask them to remember it.

Please go on remembering this name and address and I will ask you about it later.

 

ITEM 186  HERE THE SUBJECT SHOULD REMEMBER YOUR EARLIER REQUEST TO SEAL THE ENVELOPE AND WRITE THEIR INITIALS ON THE BACK.  WAIT A FEW SECONDS TO ALLOW THEM TO REMEMBER.

 

0.  No correct action

1.  One action with prompt

2.  Both actions with prompt

3.  One action without prompt, one with

4.  Seals and writes own name without prompt

5.  One action without prompt only

ITEM 186  If sealing envelope and writing initials on back is not spontaneously done, say ‘Were you going to do something else with the envelope?’

If only one action is carried out, say ‘Was there something else you were going to do?’

If initials still not written, say ‘You may remember I asked you to write something special on the back of the envelope’.  If incorrect response made, e.g. folding, say ‘Was there anything else?’  Any combination of name and/or initials is acceptable.

TAKE THE ENVELOPE BACK

 

I am going to name two things and I’d like you to tell me in what way they are alike.  For example, a dog and a monkey are alike because they are both animals.   I wonder if you can tell me:

 

Q189  In what way are an apple and a banana alike?

 

0.  Incorrect

1.  Food, grow, have peel

2.  Fruit

9.  Not asked

Q189-190  These questions assess the ability to think abstractly.  Abstract answers score 2, concrete answers score 1.

Examples are given beside each score.

Q190  In what way are a boat and a car alike?

 

0.  Incorrect

1.  Have seats

2.  Means of transport

9.  Not asked

 

Q191  What was the name and address I asked you to remember a short while ago?

 

John

0.  Not recalled

1.  Recalled

9.  Not asked

 

Brown

0.  Not recalled

1.  Recalled

9.  Not asked

 

42

0.  Not recalled

1.  Recalled

9.  Not asked

 

West Street

0.  Not recalled

1.  Recalled

9.  Not asked

 

Bedford

0.  Not recalled

1.  Recalled

9.  Not asked

 

Q191  Score each component as either correct or incorrect.

SHOW SUBJECT THE PICTURES IN THE HANDBOOK

 

Q192  These are pictures of ordinary things taken from unusual angles.  Can you tell me what they are?

 

Shoe

0.  Incorrect

1.  Correct

9.  Inapplicable

 

Spectacles

0.  Incorrect

1.  Correct

9.  Inapplicable

 

Pipe

0.  Incorrect

1.  Correct

9.  Inapplicable

Q192  Score as correct if object is recognised.  It does not have to be named correctly.

RATE:  REASONS FOR MISSING (8s AND 9s) IN COGNITIVE SECTION

 

Q193  Lastly, (subject’s name) do you take any medicine, tablets or injections of any kind, either that you buy yourself or that are prescribed by your doctor?

 

0.  No

1.  Yes

8.  No answer

9.  Not asked

Q193  Enter drug, dose, and frequency of up to 8 medications.  Ask to see the medication so that you can accurately record the information.  Check that each is taken as prescribed before entering dose and frequency.

For nursing homes, information will be available from matron.

Q194  Thank you very much for answering all these questions.  It is really helpful for us to know what things people find difficult.  Would you tell me how you feel about the interview and the questions I’ve asked you?

 

1.  Strong negative reaction

2.  Lesser negative reaction

3.  Neutral

4.  Positive reaction

Q194

 

Rate 1 – If very anxious, annoyed, worried, angry or bored.

Rate 2 – If somewhat concerned, anxious, annoyed or bored.

Rate 3 – Unconcerned.

Rate 4 – Enjoyed it.

ENTER ANY (BRIEF) COMMENTS MADE BY THE RESPONDENT.  IF COMMENTS MADE:

 

Thank you for your comments.  We like to hear how people feel, and we do take notice of what they say.

 

RATE:  WHO ANSWERED THIS LAST SECTION:

 

0.  Subject

1.  Proxy

 

(Before I can switch off the machine) I have to tidy up a few details.  It should only take a few minutes so I hope you won’t mind.

 

ITEM 196  Did the subject sound muddled?

 

0.  No

1.  Yes, infrequently

2.  Yes, persistently

9.  Inapplicable

 

ITEM 197  Did the subject appear indecisive?

 

0.  No

1.  Yes, infrequently

2.  Yes, persistently

9.  Inapplicable

 

ITEM 198  Perseveration?

 

0.  No

1.  Yes, infrequently

2.  Yes, persistently

9.  Inapplicable

ITEM 198  Perseveration is the inappropriate repetition of answers e.g.

Q Weekday?  A Tuesday

Q Month?  A Tuesday

ITEM 199  Did the subject have a poor grasp of English that interfered with the questioning?

 

0.  No

1.  Yes, English not mother tongue

2.  Yes, unable to read

3.  Yes, unable to write

4.  Neither read nor write

9.  Inapplicable

 

ITEM 200  Did the subject have poor/no eyesight that interfered with reading, writing or drawing?

 

0.  No

1.  To some extent

2.  To a marked extent

3.  Blind

9.  Inapplicable

 

ITEM 201  Did the subject have unclear/no speech that interfered with questioning?

 

0.  No

1.  To some extent

2.  To a marked extent

3.  Dumb

9.  Inapplicable

 

ITEM 202  Did the subject have hearing problems that interfered with the questioning?

 

0.  No

1.  To some extent

2.  To a marked extent

3.  Deaf

9.  Inapplicable

 

ITEM 203  Did the subject have a weakness, tremor, etc. of hand that interfered with writing, drawing or folding paper?

 

0.  No

1.  To some extent

2.  To a marked extent

3.  Use of one hand/arm only

9.  Inapplicable

ITEM 203  Do not rate benign tremor of old age such as slight shaking of the hand if it does not interfere with questioning.  Rate for Parkinsonism (described as pin rolling and may be accompanied by slow response).  Also rate here for difficulty caused by arthritis.

ITEM 20A  Do you think that the subject may have dementia?  IF YES:  Is it severe?

 

0.  No

1.  Yes, not severe

2.  Yes, severe

8.  Cannot judge

 

ITEM 204  Which respondent answered the following sections:

 

Orientation                S/P

Demographic            S/P

Risk Factors              S/P

Memory                     S/P

Sleep                          S/P

Daily Living              S/P

Smoking                    S/P

Drinking                    S/P

Cognition                  S/P

Medication               S/P

ITEM 204  This item takes this form in the paper schedule only.  In the machine form this question is asked at the end of each section.

ITEM 205  Rater’s confidence in data.

 

0.  Reasonable

1.  A few doubts

2.  Moderate doubts

3.  Grave doubts

4.  Worthless

ITEM 205

Rate 0 - if respondent gave properly considered answers to more or less all the questions.

Rate 3 - if respondent was unable or unwilling to give properly considered answers to most questions.

Rate 4 - if the answers were more or less random.

 

ITEM 206  Doubtful reliability because of

 

1.  Exaggeration

2.  Minimization

3.  Another person present

9.  Other (specify)

ITEM 206

Rate 1 - if respondent had a tendency to say yes indiscriminately.

Rate 2 -  if respondent had a tendency to say no indiscriminately.

ITEM 207  Date recorded:

 

1.  During interview

2.  After interview

ITEM 207

 

Rate 2 - if information keyed into the machine from a paper schedule

OUTCOME.  Thank you very much for helping us.  As I mentioned at the beginning, we are hoping to get a better understanding of how ageing affects us all.  We are asking who takes part whether they would be willing to be seen again in the future.  May we contact you again?

 

1.  Interview complete, willing to be seen again

2.  Interview incomplete, not willing to be seen again

3.  Interview complete, refused to be seen again

4.  Interview incomplete, refused to be seen again

 OUTCOME  After this item has been completed, the following information will be displayed on the screen.

 

AGECAT SCORE:  On (n=0-5)

MMSE SCORE:  nn (nn=0-30)

This is a longitudinal study which we hope will continue in the future.  We hope it will be possible to see you again.

 

The study is described in more detail on this sheet I am giving you now.

 

HAND OVER THE INFORMATION SHEET

 

Thank you very much.