Pre-Clinical Alzheimer's Disease Questionnaire

These questions are in regards to a clinical research study that is testing an investigational drug for people at risk of Alzheimer's disease.

You may be able to take part in this study if you:

• Are aged 65-80 years old
• Have no to mild issues with your memory
• Are willing to obtain a blood test as part of the study that checks whether you have an abnormal protein association with Alzheimer’s disease

We will ask you a series of personal health and medical questions, which we will keep confidential. The information provided will only be used for the purpose of clinical research opportunities and will not be shared with anyone except study staff. Your responses will be entered into our computer system following HIPPA compliance.  You do not have to answer any question you may feel uncomfortable answering. Your responses will determine if you are eligible to move forward in the study.