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Exploring the effects of "Long-term" COVID-19

The reality of effects on the brain of some patients with COVID-19 are now clearly established.
This survey will be repeated at several points to help assess the possible effects of an intervention on cognition in individuals with this entity.

Before starting this survey make sure you have next to you, the chronometer/ stopwatch that we provided (or one you had). 

In stopwatch mode, you will start the chronometer (right button) when directed to do so below.

Stop it (right button again) after answering the last question.

Note the total time elapsed, and enter that value at the end of the questionnaire in the space provided.

Ready?  Start the stopwatch.

          Here are five words to remember.

               museum, lemonade, grasshopper, strainer, truck

          Say them to yourself as needed to memorize them,
                                                       then move on to question 1.

 


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* 1. Enter today's date (dd/mm/yyyy)

Date

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* 2. Enter your assigned Study ID#

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* 3. What Study Day number is this?  (Check Participant's Calendar if needed)

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* 4. What is the next number in this series of numbers ?

                    6,4,2,11,9,7,31,29,27,18, ____

Enter your answer in the space provided, then click Ok.

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* 5. Select the word below that doesn't belong

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* 6. Calculate the following in your head (no calculator!):

             4+16-9+8-9+20 =

- and enter your answer below then click Ok.

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* 7. In the past week how often have you misplaced, your glasses,

your keys, your wallet, some papers, a list, or other items you needed ?

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* 8. When you prepare a recipe you know quite well, at present how often

do you have to stop to check the written recipe or wonder if

you forgot to add something ?

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* 9. Write the color in which the third word from the right is written, then click Ok.

Words & Colors

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* 10. We’ve associated a list of symbols to the numbers 1 to 9.

Those assigned symbols look like this:
Numbers & Symbols
Using the above symbol key, and your computer keyboard write the Symbols that correspond in the response field below for the following number: 5 4 8 9 6, then click Ok.

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* 11. What would you do if you found a stamped and addressed envelope on the sidewalk?
Enter your answer in the space below, then click Ok.

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* 12. Enter the following numbers in reverse order in the space provided, separated by commas, but leave out the middle two numbers:

73, 11, 21, 14, 12, 41, 88, 8, 9, 6 (example: 6, 9, etc)

Enter your answer, then click Ok.

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* 13. “Describing the emotions I feel is very easy for me.”

Pick the best answer for you.

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* 14. “Often when I get angry, I don’t clearly know why.”

Pick the best answer for you.

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* 15. "'I often feel frightened that my health will never be completely back to normal."
Pick the best answer for you.

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* 16. If you start counting backwards, subtracting 7’s from 100, what is the 5th number that you reach? Enter that number in the space provided, then click Ok. (no calculator!)

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* 17. At the start of this questionnaire, you were asked to remember 5 words.

What were those 5 words? Without going back to find them, write the words in the space provided below, then click Ok.

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* 18. Imagine that you would like to copy this question by hand, writing it out exactly as written here.

Which of these tools might be of use? Enter them in the logical order of use
as when normally carrying out this task. Omit objects that would probably be of no use.

keys, hammer, mittens, notepad, wheelbarrow, shovel, pencil, frying pan, eraser, light salad oil, gloves, potatoes, reading glasses, sandals, light source, handsaw, chair, pillowcase, wall clock, desk, thermometer, light sweater

Enter your answer in the space provided, then click Ok.

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* 19. Stop the stopwatch now!

Note the total time elapsed, and enter that value below, then click Ok.
Minutes, seconds, hundredths, like this "xx:xx.xx" Example: 11:22.14

0 of 19 answered
 

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