Survey Text

2018
2017
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2018
Survey form view entire document:  text  image
Question ID: AFD.340_00.000

Instrument Variable Name: COGCAUSE
Questionnaire File Name: Sample Adult
Question Text:
What is the MAIN reason for your difficulty [fill1: remembering/concentrating/with both remembering and concentrating]?
01 Intellectual disability (formerly known as mental retardation)
02 Developmental disability (such as cerebral palsy or autism)
03 Dementia or Alzheimer?s disease
04 Learning disability or ADHD
05 Education level
06 Mental illness (such as depression, anxiety, post-traumatic stress disorder, emotional problem)
07 Traumatic brain injury or stroke
08 Age-related changes
09 Chronic health condition (such as diabetes, high blood pressure, heart disease, cancer, multiple sclerosis, Parkinson?s disease, epilepsy)
10 Drugs or medications
11 Other (specify)
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have some difficulty, a lot of difficulty, or are unable to remember or concentrate, or don't know or refused if they are able to remember or concentrate
Skip Instructions:
(1-10,R,D) [goto UB_SS];
(11) [goto COGSPEC]

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2017
Survey form view entire document:  text  image
Question ID: FDB.130_00.000

Instrument Variable Name: PDFCAUSE
Questionnaire File Name: Family
Question Text:
What is the MAIN reason for [fill 1: your/ALIAS's] difficulty concentrating, remembering or making decisions?
01 Intellectual disability (formerly known as mental retardation)
02 Developmental disability (such as cerebral palsy or autism)
03 Dementia or Alzheimer?s disease
04 Learning disability or ADHD
05 Education level
06 Mental illness (such as depression, anxiety, post-traumatic stress disorder, emotional problem)
07 Traumatic brain injury or stroke
08 Age-related changes
09 Chronic health condition (such as diabetes, high blood pressure, heart disease, cancer, multiple sclerosis, Parkinson?s disease, epilepsy)
10 Drugs or medications
11 Other (specify)
97 Refused
99 Don't know
Universe Text: All persons 5 or older who have difficulty concentrating or remembering
Skip Instructions:
(1-10,R,D) if no more persons AGE )=1, [goto next section];
else return to P2DFHEAR for next person AGE )=1
(11) [goto PDFSPEC]