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Physiological Alterations due to Neuronal Degeneration in Elderly People
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
How often do you experience memory loss?
Please select the frequency of memory loss.
Rarely
Occasionally
Frequently
2
Rate the severity of your motor coordination issues
Please rate the severity of your motor coordination issues.
3
Describe any speech difficulties you may have encountered
Please provide a description of any speech difficulties.
4
Do you experience any tremors in your hands or legs?
Please indicate if you experience tremors in your hands or legs.
Yes
No
5
Rate the frequency of your mood swings
Please rate the frequency of your mood swings.
6
Do you find it difficult to perform daily activities?
Please indicate if you find it difficult to perform daily activities.
Yes
No
7
Rate the level of fatigue you experience
Please rate the level of fatigue you experience.
8
Are you experiencing any changes in your sense of smell or taste?
Please indicate if you are experiencing changes in your sense of smell or taste.
Yes
No
9
Describe any vision problems you may be facing
Please provide a description of any vision problems.
10
Rate the level of concentration you have during cognitive tasks
Please rate the level of concentration you have during cognitive tasks.
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