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2022

Survey form view entire document: text image

Question ID: COG.0010.00.1
Variable: COGMEMDFF_A
Interview Module: Adult
Content Type: Annual Core

Question text:

Do you have difficulty remembering or concentrating?
*Read if necessary: Would you say no difficulty, some difficulty, a lot of difficulty, or you
cannot do this at all?

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1,RF,DK [goto next section]
2-4 [goto COGTYPEDFF_A]

Survey form view entire document: text image

Question ID: COG.0020.00.1
Variable: REMEMBERDF_C
Interview Module: Child
Content Type: Annual Core

Question text:

Compared with children of the same age, does ^SCNAME have difficulty remembering things?
*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of
difficulty, or ^heshe_C cannot do this at all?

Fills:

^SCNAME

Description: Sample child's name
Instruction:
Fill ALIAS of HHSTAT_C=1

^heshe_C

Description: He/She/They
Instruction:
If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She"
elseif SEX_FINAL_C =blank: fill "They"

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Children 5-17

Skip Instructions:

1-4,RF,DK [goto next section]

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2021

Survey form view entire document: text image

Question ID: COG.0010.00.1
Variable: COGMEMDFF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty remembering or concentrating?
Read if necessary: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1,RF,DK [goto next section]
2-4 [goto COGTYPEDFF_A]

Survey form view entire document: text image

Question ID: COG.0020.00.1
Variable: REMEMBERDF_C
Interview Module: Child
Content Type: Annual Core
Question text:

Compared with children of the same age, does ^SCNAME have difficulty remembering things?
Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?

Fills:

^SCNAME

Description: Sample child's name
Instruction:
Fill ALIAS of HHSTAT_C=1

^heshe_C

Description: He/She/They
Instruction:
If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She"
elseif SEX_FINAL_C =blank: fill "They"

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Children 5-17

Skip Instructions:

1-4,RF,DK [goto next section]

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2020

Survey form view entire document: text image

Question ID: COG.0010.00.1
Variable: COGMEMDFF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty remembering or concentrating?
*Read if necessary: Would you say no difficulty, some difficulty, a lot of difficulty, or you
cannot do this at all?

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1,RF,DK [goto next section]
2-4 [goto COGTYPEDFF_A]

Survey form view entire document: text image

Question ID: COG.0020.00.1
Variable: REMEMBERDF_C
Interview Module: Child
Content Type: Annual Core
Question text:

Compared with children of the same age, does ^SCNAME have difficulty remembering things?
*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of
difficulty, or ^heshe_C cannot do this at all?

Fills:

^SCNAME

Description: Sample child's name
Instruction:
Fill ALIAS of HHSTAT_C=1

^heshe_C

Description: He/She/They
Instruction:
If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She"
elseif SEX_FINAL_C =blank: fill "They"

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Children 5-17

Skip Instructions:

1-4,RF,DK [goto next section]

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2019

Survey form view entire document: text image

Question ID: COG.0010.00.1
Variable: COGMEMDFF_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Do you have difficulty remembering or concentrating?

*Read if necessary: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Response:

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know

Universe:

Sample Adults 18+

Skip Instructions:

1,RF,DK = [goto next section]
2-4 = [goto COGTYPEDFF_A]

Survey form view entire document: text image

Question ID: COG.0020.00.1
Variable: REMEMBERDF_C
Interview Module: Child
Content Type: Annual Core

Question Text:

Compared with children of the same age, does ^SCNAME have difficulty remembering things?

*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"

Response:

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know

Universe:

Sample Children 5-17

Skip Instructions:

1-4,RF,DK = [goto next section]

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2018

Survey form view entire document: text image

Question ID: AFD.300_00.000

Instrument Variable Name: COG_SS
Questionnaire File Name: Sample Adult
Question Text:

Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1)[goto UB_SS]
(2-4,R,D)[goto COG_1]

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2017

Survey form view entire document: text image

Question ID: AFD.300_00.000

Instrument Variable Name: COG_SS
Question Text:

Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions: (1) [go to UB_SS] (2-4,R,D)[go to COG_1]

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2016

Survey form view entire document: text image

Question ID: AFD.300_00.000

Instrument Variable Name: COG_SS
Question Text:

Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions: (1) [go to UB_SS] (2-4,R,D)[go to COG_1]

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2015

Survey form view entire document: text image

Question ID: AFD.300_00.000

Instrument Variable Name: COG_SS
Question Text:

Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions: (1) [go to UB_SS] (2-4,R,D)[go to COG_1]

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2014

Survey form view entire document: text image

Question ID: AFD.300_00.000

Instrument Variable Name: COG_SS
Question Text:

Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions: (1) [go to UB_SS] (2-4,R,D)[go to COG_1]

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2013

Survey form view entire document: text image

Question ID: AFD.300_00.000

Instrument Variable Name: COG_SS
Question Text:

Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions: (1) [go to UB_SS] (2-4,R,D)[go to COG_1]

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2012

Survey form view entire document: text image

Question ID: AFD.300_00.000

Instrument Variable Name: COG_SS
Question Text:

Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions: (1) [go to UB_SS] (2-4,R,D)[go to COG_1]

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2011

Survey form view entire document: text image

Question ID: AFD.300_00.000

Instrument Variable Name: COG_SS
Question Text:

Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions: (1) [go to UB_SS] (2-4,R,D)[go to COG_1]

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2010

Survey form view entire document: text image

Question ID: QOL.300_00.000

Instrument Variable Name: COG_SS
QuestionText:

Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:

(1)[goto UB_SS]
(2-4,R,D)[goto COG_1]

Survey Text