47 PCN Functional Activities Questionnaire
Score each question on a 4 point scale:
- 0 = normal,
- 1 = does with difficulty,
- 2 = requires assistance,
- 3 = dependent
In the past 4 weeks, did the patient have any difficulty or need help with:?
- writing checks, paying bills, keeping financial records
- assembling tax records, business affairs, papers
- shopping alone – clothes, household, groceries
- playing a game of skill or working on a hobby
- heating water, making coffee, turning off stove
- preparing a balanced meal
- keeping track of current events
- paying attention to, understanding, or discussing a TV program/book/magazine
- remembering appointment, family occasion, holiday, medication
- traveling out of the neighborhood, driving, arranging to take bus
Scoring:
- normal = 0-1
- mild cognitive impairment = 4-9
- mild dementia = 10-13
