Screening Tool Topic C. Cognitive & Emotional Function Patient Details Patient Name: Patient ID: DASHBOARD Quiz 🎯Topic C. Cognitive & Emotional Function C1. Memory Problems Have you faced any difficulties with your memory in the past year, such as forgetting where you put items or leaving tasks incomplete? Yes Occasionally Not really Not able to assess / Unwillingness to respond 🎯Topic C. Cognitive & Emotional Function C2. Use of Money Do you handle your finances independently, or do you require assistance managing your money? Independent Needs assistance Not able to assess / Unwillingness to respond 🎯Topic C. Cognitive & Emotional Function C3. Loss of Loved One/Close Relative Have you recently experienced the passing of a loved one or close relative (within the past year)? Yes No Not able to assess / Unwillingness to respond 🎯Topic C. Cognitive & Emotional Function C4. Difficulty Making Decisions\ Do you find it challenging to make decisions in your daily life, such as deciding what to eat, what clothes to wear, or going to the doctor? Yes No Maybe Not able to assess / Unwillingness to respond 🎯Topic C. Cognitive & Emotional Function C5. Trauma Have you gone through any very difficult or upsetting events in your lifetime including abuse, violence, trauma? You do not have to explain what happened. Yes Possible No Not able to assess / Unwillingness to respond 🎯Topic C. Cognitive & Emotional Function C6. Speech/Language Difficulties Do you experience any challenges with speaking or understanding language? Yes Possible No Not able to assess / Unwillingness to respond 🎯Topic C. Cognitive & Emotional Function C7. Confusion/Delirium Do you ever feel confused or disoriented? Yes Possible No Not able to assess / Unwillingness to respond 🎯Topic C. Cognitive & Emotional Function C8. Hallucinations Do you experience seeing or hearing things that others do not? Yes Possible No Not able to assess / Unwillingness to respond Next question ➜ ANSWERS