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Alzheimer's Research: Please take 5 Minutes and Support Alzheimer's research by answering the following questions (For United States Only)
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* Indicates required question
Are you willing to participate in a brief survey to help with Alzheimer's disease research?
*
Yes
No Thank You
Do You live in the United States
*
Yes
No (If not, please close this form now. This research only includes adults living in the US)
Are you over the age of 18?
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Yes
No (If not, please close this form now)
How old are you?
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Your answer
What is your sex/gender?
Male
Female
Other/non binary
Prefer not to say
Clear selection
How tall are you? (Please use feet and inches)
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Your answer
What is your waist size in inches? (if you don't know the exact number, please guess as closely as you can)
*
Your answer
How much do you weigh? (pounds)
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Your answer
Compared with someone your age, how good has your memory been over the past 6 months? (Check the answer that best describes your memory over the past 6 months)
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Severe Memory Loss
Some Memory Loss
No Memory Loss
Good Memory
Excellent Memory
Do you have Diabetes or Prediabetes?
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Yes, Diabetes
Yes, Prediabetes
I don't know
No, I do not have Diabetes or Prediabetes
Do you play the Card Game Bridge? How often do you play?
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Yes, I play every week
Yes, I play once or twice a month
Yes, I play rarely, only a few times a year
No, I don't play Bridge.
Do you play Chess? How often do you play?
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Yes, I play every week
Yes, I play once or twice a month
Yes, I play rarely, only a few times a year
No, I don't play Chess
What is your highest level of Education?
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Some High School
High School Graduate or GED
Some College
College Graduate
Masters Degree
PhD/MD/JD
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