Healthy Aging Brain Center - Caregiver Monitor

The HABC Monitor is an instrument developed for the purpose of assessing and monitoring symptoms of dementia over time. The instrument covers the four clusters of dementia symptoms: cognitive, functional, behavioral and mood, and caregiver stress. The HABC Monitor depends on self-reports and informal caregiver reports that do not require the presence of a clinician or facilitator and can be completed through paper, web, or telephone based templates.
Over the past 2 weeks how often did your loved one have problems with: Not at all
(0-1 day)
Several days
(2-6 days)
Most days
(7-11 days)
Almost Daily
(12-14 days)
Judgment or decision-making
Repeating the same things over and over such as questions or stories
Forgetting the correct month or year
Handling complicated financial affairs such as balancing checkbook & paying bills
Remembering appointments
Thinking or memory
Learning how to use a tool, appliance, or gadget
Planning, preparing or serving meals
Taking medications in the right dose at the right time
Walking or physical ambulation
Shopping for personal items like groceries
Housework or household chores
Leaing her/him alone
Her/his safety
Her/his quality of life
Falling and tripping
Less interest or pleasure in doing things, hobbies, or activities
Feeling down, depressed, or hopeless
Being stubborn, agitated, aggressive or resistive to help from others
Feeling anxious, nervous, tense, fearful or panic
Believing others are stealing from them or planning to harm them
Hearing voices, seeing things or talking to people who are not there
Poor appetite or overeating
Falling asleep, staying asleep, or sleeping too much
Acting impulsively, without thinking through the consequences of her/his actions
Wandering, pacing, or doing things repeatedly
Over the past 2 weeks how often did you have problems with: Not at all
(0-1 day)
Several days
(2-6 days)
Most days
(7-11 days)
Almost Daily
(12-14 days)
Your quality of life
Your financial future
Your mental health
Your physical health
Cognitive Subscale: 0
Functional Subscale: 0
Behavioral and Mood Subscale: 0
Caregiver Stress Subscale: 0
Total Score: 0
After printing, please bring the completed form(s) to your appointment where it will be scored and discussed during your office visit.