Section B: Cognitive Evaluation

Section B: Cognitive Evaluation Module of CRELES Wave 1

Label Type Description
B1 Question Please tell me today's date. (note 1 point for each correct response)
B2 Question Now I am going to name 3 objects. After I name them I am going to ask you to repeat aloud the words that you can remember in whatever order. Please remember what the words are because I will ask you again later in the interview. Do you have any questions? (Remembered 1, Did not remember 0)
B3 Question Now I will state some numbers and I want you to repeat them in reverse order. 1 3 5 7 9 Note: Write 1 if the order is correct (9 7 5 3 1) and 0 for any other response.
B4 Question I am going to give you a sheet of paper. Take the paper with your RIGHT HAND, fold it in HALF with BOTH HANDS and place it ON YOUR LAP (Correct action 1, incorrect 0)
B5 Question A moment ago I named three objects and you repeated the ones you remembered, Tell me which ones you remember now. (Remembered 1, Did not remember 0)
B6 Question Please copy the drawing that I am handing to you. (The action is correct is the circles are not overlapping by more than half. Note one point if the drawing is correct).
B7 Question Is there someone who normally resides in this home who might be able to help us answer some questions?
B8 Question Is _____ able to manage her/his own money?
B9 Question Is _____ able to do her/his own shopping (food, clothes)?
B10 Question Is _____ able to heat water for coffee or tea and to turn off the stove?
B11 Question Is _____ able to prepare her/his own meals?
B12 Question Is _____ able to keep up with happenings and what is occurring in the neighborhood?
B13 Question Is _____ able to pay attention, understand and discuss a radio or television program or an article in the newspaper?
B14 Question Is _____ able to remember commitments and family activities?
B15 Question Is _____ able to manage or administer her/his own medications?
B16 Question Is _____ able to walk around the neighborhood and find her/his way home?
B17 Question Is _____ able to greet his friends adequately?
B18 Question Is _____ able to stay home alone without problems?
B19 Question Add the points of questions B9 to B19 and note the total