This sample report is based on an ADCQ. It is provided as an example of the type of information you will find in the ADCQ Caregiver's Report. The information provided in the report will be based on the responses that were provided on the instrument.

 

Alzheimer's Disease Caregiver's Questionnaire™ (ADCQ™)


Caregiver's Report (Sample)

Name:
 Sample Client
Client ID:
 12345
Date ADCQ completed
 10/29/2002
Age:
 85
Gender:
 Male
Times seen per week:
 3
Telephone calls per week:
 6 -10
Living arrangements
 Assisted living/community care
Rated by:
 Sample Rater

 

Background

Thank you for completing the Alzheimer's Disease Caregiver's Questionnaire (ADCQ). The ADCQ questions assess problems that are often experienced by people suspected of having Alzheimer's disease. Research with the ADCQ has indicated that its scores can identify those individuals who are suspected of having Alzheimer's disease. Alzheimer's disease is characterized by problems in memory, reasoning and judgment, planning and organization, language, and spatial abilities. These problems often develop gradually and can greatly interfere with an individual's ability to function independently. Other medical and/or psychiatric conditions may also affect areas of functioning similar to those affected by Alzheimer's disease. It is important that you understand that this questionnaire is not designed to provide a diagnosis of Alzheimer's disease. This report does not take the place of an evaluation conducted by a qualified health care professional. You should consult a qualified professional if you have concerns about the rated individual.

This report provides feedback that may be a useful source of information for making a decision about whether to obtain a more thorough evaluation for the individual you rated.  This feedback may also help to summarize your observations of the person being rated, and it may be very helpful for a health care provider who is evaluating the rated individual.  The ADCQ web site contains additional information that can help you locate an appropriate health care professional.  Technical information about the ADCQ can be obtained through the main ADCQ web site (www.adcq.net).

PAR Psychological Assessment Resources, Inc. • 16204 N. Florida Avenue • Lutz, FL 33549
Copyright 2002 by Psychological Assessment Resources, Inc. All rights reserved. May not be reproduced in whole or in part in any form or by any means without written permission of Psychological Assessment Resources, Inc.
Version 1.00.003

 

ADCQ Results 

Based on your answers on the ADCQ, the individual you rated has the following difficulties:

He repeats himself in conversation. He has difficulty remembering recent events.

He becomes confused when performing routine activities. He becomes confused about the date, month, or year.

He has difficulty recognizing locations and/or traveling between locations.

He has some problems with reasoning and judgment.

He has demonstrated some language difficulties.

His problems seem to be getting worse over time.

Dementia is a loss of functioning in areas such as memory, language, and reasoning. This loss of functioning is often severe enough to interfere with daily activities and quality of life. Alzheimer's disease is one type of dementia characterized by problems in memory, reasoning and judgment, planning and organization, language, and spatial abilities. The probability that the rated individual has a dementia suggestive of Alzheimer's disease is Likely. However, it is possible that the problems you identified on the ADCQ are the result of another type of problem, such as a dementia other than Alzheimer's disease, a psychiatric disorder, or some combination of both. The ADCQ cannot provide a diagnosis of Alzheimer's disease, but a qualified health care professional can help determine the cause of these problems and can develop a treatment plan. Based on the results of this screen, we suggest that you contact a qualified health care professional for further evaluation.

 

Recommendations

The following recommendations are made based on the results from your ADCQ ratings:

Your ADCQ answers suggest that the rated individual is likely to have a dementia characteristic of Alzheimer's disease. It is recommended that you have this person evaluated by a qualified health care professional in order to determine the cause of these problems. Please note that it is inappropriate to make a diagnosis of Alzheimer's disease based only on the results of the ADCQ.

You indicated that the individual you rated is at or over the age of 65. The chance of developing Alzheimer's disease increases with age, especially once a person reaches age 65. The highest rates of the disease occur in individuals 85 years of age and older.

The results of the ADCQ are based on the assumption that you have had sufficient contact with the rated individual. This feedback should also be interpreted cautiously if your ability to observe and/or speak with this person is or has been limited.

To obtain more information about Alzheimer's disease, you can go to the ADCQ web site home page (www.adcq.net) or contact the following organizations:

Alzheimer's Disease Education and Referral Center
P.O. Box 8250
Silver Spring, MD 20907-8250
www.nia.nih.gov/alzheimers
1.800.438.4380

Alzheimer's Association
919 North Michigan Avenue
Suite 1100
Chicago, IL 60611-1676
www.alz.org
1.800.272.3900

Item Responses

 

1. Does the person repeat questions about the events of the day?
Yes

2. Does the person have trouble recalling conversations the next day?
Yes

3. Does the person have trouble recalling conversations a few days later?
Yes

4. Has there been confusion while doing familiar things?
Yes

5. Has the person become confused about financial matters (for example, paying bills multiple times)?
No

6. Has the person become confused regarding the day, month, or year?
Yes

7. Has the person become lost or confused when driving or walking in a familiar place?
No

8. Has the person seemed bewildered or confused in familiar places?
Yes

9. Has the person become lost while traveling in an unfamiliar location?
Yes

10. Does the person have difficulties adjusting to changes in his/her day-to-day routine?
No

11. Does the person have trouble performing tasks that require many steps (for example, balancing a checkbook or cooking a meal)?
Yes

12. Is the person unable to respond with a reasonable plan to problems at work or home, such as knowing what to do if the bathroom is flooded or the electricity goes out?
Yes

13. Are there pauses in his/her speech?
No

14. Is the person often unable to find even common words or familiar names, so that he/she finds it difficult to have a normal conversation?
Yes

15. Does the person often forget what he/she wanted to say in the middle of a conversation?
No

16. Have there been any changes in personality (including mood and behavior)?
No

17. Has the person been agitated?
No

18. Have the person's problems worsened steadily?
Yes