Alzheimer’s Prevention Check
Answer these questions as best you can. Your results will be emailed to you.
How many times a day do you eat white rice, white bread, flour, desserts, or other refined foods?
None/Rarely
1 a day or less
2 a day
3 a day
3+ a day
How many sugar-based snacks (biscuits, cakes, chocolate, sweets) or soft drinks/soda (with added sugar or syrup) do you consume each day?
None/Rarely
1 a day or less
2 a day
3 a day
3+ a day
How many times a week do you eat fresh oily fish (e.g. salmon, mackerel, sardines, herring)?
None
Less than 1 a week
1 a week
2 a week
3+ a week
Do you take a fish oil supplement or a supplement containing Omega-3 DHA? If so, how much?
No
Don't know
Less than 250mg
250-499mg
500mg or more
How frequently do you eat raw walnuts, pecans, macadamia, chia or flax seeds? (a handful or small cup)
Never
Rarely/occasionally
2-3 a week
3-5 a week
At least 1 a day
Do you supplement with vitamin D, and if so, by how much?
No
400iu a day
500-1000iu (25mcg)
>1000-3,000iu (75mcg)
>3,000iu (>375mcg)
How many servings of berries, cherries, plums, pomegranate or their juice do you have a day?
Never/rarely
1-2 a week
4 or more a week
Most days
2 or more a day
How many servings of orange or red vegetables do you have a week? (e.g. carrot, beetroot, sweet potato, squash, peppers)
None
1 a week or less
2-3 a week
3-4 a week
5+ a week
How many times a week do you eat dark green or cruciferous vegetables? (e.g. broccoli, cabbage, cauliflower, brussels sprouts)
Never/Rarely
1 a week or less
2-3 a week
3-6 a week
Most days
How many times a week do you eat fried, deep-fried, or browned foods, including crisps, chips, and fried takeaway food?
Never/Rarely
1 a week or less
2-3 a week
3-6 a week
Most days
Do you smoke cigarettes, and if so, how many?
No/none
5 or less a day
5-10 a day
10-20 a day
20+ a day
How many times a day do you eat vegetable protein? (e.g. beans, lentils, tofu, quinoa, peas, corn)
None/Rarely
1 or 2 a week
Every other day
Once a day
2+ a day
How many times a week do you eat a serving of meat, fish, eggs, cheese or dairy products?
None/Rarely
1 or 2 a week
Every other day
Once a day
2+ a day
Do you take supplements containing vitamin B12, and if so, how much do you take?
None
10 - 50mcg
51 - 250mcg
251 - 499mcg
500mcg or more
Do you take folic acid, and if so, how much do you take?
No
100 - 199 mcg
200 - 399 mcg
400 -799 mcg
800 mcg or more
How many alcoholic drinks or units of alcohol do you have a week?
None/rarely
less than 4
5 to 10
10 to 20
20+
How many days per week do you spend at least 20 minutes doing light physical activities such as walking, gardening, housework, or repairing things?
None/rarely
A couple of times a month
1 or 2 a week
Every other day
Almost every day
How much time per week do you do energetic activities such as dancing, cycling, swimming, playing tennis/squash, gym or exercise classes, running, or competitive sport?
None/rarely
A couple of times a month
1 or 2 a week
Every other day
Almost every day
How many days per week do you spend time with other people in a social (not work) setting (groups, friends, family, etc)?
None/rarely
A couple of times a month
1 or 2 a week
Every other day
Almost every day
Do you regularly practice a new skill you are not an expert in (e.g. new language, sport, musical instrument, etc)?
No/Nothing
Occasionally
Once a week or less
2-3 times a week
Almost every day
How many hours do you spend in bed each night, including time having a nap or siesta?
More than 8 hours
7 - 8 hours
6 - 7 hours
5 - 6 hours
less than 5
Do you have difficulty sleeping, find it hard to fall asleep, or sleep through the night (including regularly taking pills to sleep)?
Never
Rarely
Sometimes
Frequently
Always
Do you get anxious, tense, angry or irritable easily?
Never
Rarely
Sometimes
Frequently
Always
Do you have at least one bowel movement per day?
Every day
Most days
Some days
Occasionally
No
Do you take antacids most days for indigestion?
No
Rarely
Occasionally
Often
Always
Do you suffer from excessive wind, flatulence, abdominal bloating, or IBS?
Never
Rarly
Sometimes
Often
Always
Do you have periodontal or gum disease?
No/don't know
A little
Yes-badly
Do you have high blood pressure? If yes, what's your most recent reading?
Don't know/Healthy (eg 100-125/70-85)
140-150/90-100
151-160/101-105
>160-170/106-110
>170/>110
Has your doctor said you have a glucose problem or diagnosed you with pre-diabetes or diabetes?
No
Pre-diabetic or glucose problem, or diabetes in remisssion with no medication
Maintaining slightly raised fasting glucose levels with diet alone
Maintaining slightly raised fasting glucose (below 6) with medication
Yes
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