Do you practice in the United States? * Yes No What is your highest attained degree? * MD/DO PhD PA NP RN Other... What is your highest attained degree? Other... What is your specialty? * Neurology Psychiatry Geriatrics Family Practice Internal Medicine Other... What is your specialty? Other... How many years have you been in practice? * <5 years 5 to <10 years 10 to <20 years 20 to <30 years 30 years or more Which best describes your current practice setting? * Community-based Academic Hospital-based Government facility Not currently practicing Other... Which best describes your current practice setting? Other... Do you initiate a conversation about cognitive problems with your patients as part of a routine exam? * Yes No I don’t initiate the conversation but will address cognitive complaints or issues my patients may have How confident are you in your ability to accurately diagnose Alzheimer’s disease and differentiate it from other forms of dementia? * Very confident Confident Somewhat confident Not very confident Not at all confident Do you conduct any regular screening procedures for Alzheimer’s disease? * Yes No If you do conduct regular screening to assess your patients’ cognitive status, which of the following tool(s) do you use on a routine basis? * Mini Mental State Exam (MMSE) Any validated informant assessment tools Clock drawing test General Practitioner Assessment of Cognition (GPCOG) Memory Impairment Screen (MIS) Mini-Cog Montreal Cognitive Assessment (MoCA) The Alzheimer’s Disease 8 (AD8) None of the above Other... If you do conduct regular screening to assess your patients’ cognitive status, which of the following tool(s) do you use on a routine basis? Other... What percent of your patients actually have a formal diagnosis of Alzheimer’s disease? * 0% 1-10% 11-20% 21-30% 31-40 % >40% Which, if any, of the following medications for treating Alzheimer’s disease do you sometimes prescribe? * Donepezil Galantamine Memantine Rivastigmine Donepezil + memantine An antipsychotic An antidepressant None of the above Other... Which, if any, of the following medications for treating Alzheimer’s disease do you sometimes prescribe? Other... How adherent are your patients with Alzheimer’s disease to the medications you prescribe? * Very adherent Somewhat adherent Not very adherent Not sure Please rate your opinion of the efficacy of the currently available medications for Alzheimer’s disease: * Very efficacious Somewhat efficacious Not very efficacious Not at all efficacious Do you believe that currently available therapies to manage Alzheimer’s disease offer some disease-modifying properties in addition to offering symptomatic benefits? * Yes No If you are interested in participating in the raffle for a $100/€100 Amazon gift card, please fill out the following: First Name: Last Name: Email: Leave this field blank
