1. Write down the date, month and year.
2. Look once only at the words below then cover them up. When you have finished all the questions here, write down from memory what the three words are: ORANGE, TELEVISION, CUSHION.
3.Without looking at your watch, write what time you think it is. Then look at your watch and write down the actual time.
4. What are the names of the last five Hungarian Prime Ministers?
5. Can you remember the address of the last place that you lived?
6. Can you recall what you were doing on each of the previous seven evenings?
7. Have people told you that you repeat yourself in conversation, or have you found yourself doing this?
8. Are you aware that people are getting irritated with you because you have forgotten something?
9. Do you ever return from shopping to find you have forgotten an essential item?
10. Do you find it increasingly difficult to follow directions?
11. Do you get lost in places that you have visited frequently?
12. Do you have trouble recalling words, even though you know that you know them?
13. Do you misplace things practically every day?
14. Are your memory difficulties impinging on your work or social life- e.g. do you sometimes avoid people because you cannot remember their names?
Now, without looking back, write down the three words you memorised earlier.
1. Give yourself 1 point for remembering the exact date.
2. Give yourself 1 point for each of the words you remembered correctly.
3. If the difference between your guessed time and the actual time is less than 30 minutes, give yourself 1 point; if the difference is more than 30 minutes, score zero.
4. Award yourself 1 point for each Prime Minister named correctly, they do not have to be in order- Viktor Orbán, Gordon Bajnai, Ferenc Gyurcsány, Péter Medgyessy, Gyula Horn.
5. Give yourself 1 point for remembering your last address.
6. Give yourself 1 point if you answered YES.
7-14. Give yourself 1 point for every NO answer.
16-20: Your memory is fine and you show no signs of memory loss.
15-12: You may have some memory difficulties. If they persist and are causing you inconvenience or make you inefficient or embarrassed, you might want to talk to your GP about it.
11 or less: Your result suggests some memory impairment and you need to visit your GP for advice.