Pre-Visit Memory & Daily Routine Check-In
A free, private pre-visit organization guide to help you or a loved one note everyday memory changes—and prepare a clear summary for your doctor.
Over half of adults aged 45+ with subjective cognitive decline have never discussed it with a healthcare provider (CDC BRFSS).
Mean time between first noticed symptoms and receiving a dementia diagnosis across pooled studies (Kusoro et al., 2025).
Estimated share of mild cognitive impairment cases that remain undiagnosed in primary care settings (Liu et al., 2024).
First pages give a plain-English action guide & card breakdown; the final page provides organized observations for your doctor.
How CogniGlass Works in 3 Simple Steps
Designed for effortless reading, plain language for you, and organized pre-visit notes for your doctor.
Choose Who It Is For
Select "For Myself" (which includes 18 everyday questions plus 3 short word-memory, date, and sequence activities) or "For a Loved One" (an observational questionnaire for a spouse, parent, or relative).
Check Everyday Routines & Health Factors
Move one card at a time at your own pace. Along with everyday memory and routine questions, we check for common sleep aids, allergy pills, and health conditions (like sleep quality, thyroid, or hearing) that can cause reversible "brain fog."
Print or Save Your Report
Receive your results immediately with no sign-up or email required. Keep the Patient Summary & Card Breakdown pages for yourself and hand the Physician Report (final page) directly to your primary care doctor/specialist at the start of your next appointment.
Ready to begin? Choose a mode to jump right in:
Structured Pre-Visit Memory & Routine Architecture
To eliminate redundant questions while giving primary care physicians clear, organized observations for cognitive office visits, our original 18-item questionnaire and 3 brief home activities organize information across 6 established clinical domains:
1. 8-Item Change Check (0–8)
An 8-item intra-individual change domain (AD8-aligned construct) that notes everyday shifts in repetition, temporal orientation, everyday judgment, and hobbies without making a medical diagnosis.
2. 11-Item Routine Change Check (0.0–11.0)
An 11-item subjective 1-year cognitive routine check (CFI-aligned construct) designed to organize subtle perceived changes in conversations, directions, finances, and appointments.
3. 10-Item Everyday Activities Check (0–30, Prorated)
A 10-item instrumental daily activities domain (FAQ / IADL-aligned construct) tracking whether help is needed in complex tasks (finances, forms, shopping, meal prep, travel), prorating tasks never performed historically.
4. 4-Word Controlled Cued Recall (0–8)
Uses 4-word controlled category learning and delayed category-cued recall (Buschke paradigm) from an original 160-word bank to observe whether category hints assist word recall.
5. Temporal Orientation (0–4)
4-item calendar orientation check (Year, Month, Date of Month with ±1 day tolerance, and Day of the Week) organized for primary-care pre-visit review.
6. Digital Trail-Making A & B
Measures Part A motor tapping pace (1–5) and Part B alternating sequence pace (1-A-2-B-3-C-4-D-5-E) as unnormed home-task timing observations alongside self-reported motor or vision notes.
Note: Original pre-visit communication items only; CogniGlass is not an official, normed, or cleared medical device or clinical test administration. Version 0.112 (November 2026).
Privacy, Ethics & Non-Diagnostic Notice
Zero-PII & Opt-In Control: CogniGlass never asks for your name, email address, phone number, street address, or birth date, and generates your complete printable summary locally in your browser. Static website delivery runs through Cloudflare's edge network (standard transit HTTP metadata applies at the network edge), while zero assessment answers are written to any database unless an adult in "For Myself" mode manually checks the optional, off-by-default research opt-in box (disabled automatically for "For a Loved One" mode and sample cases).
Communication Aid, Not a Diagnosis or Reassurance: CogniGlass organizes observations for a primary care physician or specialist. It does not diagnose Alzheimer's disease or MCI, nor do low change counts or strong home-activity scores guarantee the absence of a medical condition.
Psychometric Copyright, Licensing & Construct-Alignment Disclosure: CogniGlass uses 100% original question wording, an original 160-word semantic stimulus bank, and custom home activities to organize pre-visit information; it is not an official administration of any third-party copyrighted instrument:
- Instruments Subject to Commercial Copyright / Licensing: The official AD8® Dementia Screening Interview (copyrighted & trademarked by Washington University in St. Louis; free for non-profit clinical/research use, commercial license required), the Alzheimer's Disease Cooperative Study Cognitive Function Instrument (ADCS CFI) (copyrighted by UC San Diego / ADCS; permission required for commercial use), and the official Buschke Memory Impairment Screen (MIS) word forms (copyrighted by Albert Einstein College of Medicine / Yeshiva University; commercial license required) are proprietary instruments. CogniGlass does not reproduce their verbatim forms or proprietary word lists, and instead computes an original 8-Item Change Domain, 11-Item Routine Change Construct, and 4-Word Controlled Cued Recall.
- Public-Domain / Open Clinical Paradigms: The Trail-Making Test (Parts A & B) paradigm (originally developed for the 1944 U.S. Army Individual Test Battery), standard 4-item Calendar Orientation questions (Year, Month, Date, Day of Week), the AGS Beers Criteria® / Anticholinergic Cognitive Burden (ACB) medication class groupings, and the general 10-domain Instrumental Activities of Daily Living (IADL / Pfeffer FAQ) framework represent open clinical literature or U.S. government public-domain paradigms, implemented here with original CogniGlass wording.
- Intended Non-Commercial Scope & Normative Notice: CogniGlass is provided as a free public-health and educational pre-visit communication aid. All trademarks and instrument names cited in clinical literature references remain the property of their respective academic institutions. Because items are harmonized into a single 18-question intake flow and administered digitally on personal screens without a psychometrician present, home-activity results represent unnormed pre-visit observations rather than standardized clinical scores.
Medical & Legal Disclaimer: CogniGlass, its creator, and everyone associated with this project are not licensed healthcare providers and assume no medical, clinical, or legal responsibility or liability for any health decisions, interpretations, diagnoses, treatments, or outcomes resulting from the use of this website or its generated reports. This questionnaire is strictly an informational and self-advocacy tool to assist in conversations with your physician, and does not establish a doctor-patient relationship. Always consult a qualified healthcare professional regarding any cognitive or medical concerns, and seek immediate emergency care (call 911) if you or a loved one experience sudden or acute neurological changes.