Instructions:

Rate each statement based on how often it has been true over the past 30
days.

0 = Never 1 = Rarely 2 = Sometimes 3 = Often

Brain Wellness Checklist

Assess your cognitive health in minutes.

Step 1 / 1

Memory & Thinking

I frequently forget names, appointments, or why I entered a room.
I have trouble concentrating on tasks.
I frequently forget names, appointments, or why I entered a room.
I find it harder to learn new information than I used to.
I struggle to find the right words when speaking.

Sleep & Recovery

I wake up feeling tired or unrested.
I sleep fewer than 7 hours most nights.
I wake frequently during the night.
I snore loudly or have been told I stop breathing while sleeping.

Hormones & Mood

I experience brain fog most days.
I have frequent mood swings or irritability.
I have hot flashes or night sweats.
I feel more anxious than I did a few years ago.

Metabolic & Physical Health

My waist circumference has increased over the past few years.
I rarely participate in strength training or regular exercise.
I have high blood pressure, high cholesterol, or elevated blood sugar.
I often feel fatigued despite adequate rest.

Nutrition

I eat fewer than five servings of vegetables and fruit each day
I eat processed or fast foods several times each week.
I rarely eat fish, nuts, olive oil, or other healthy fats.
I often skip meals or consume excess sugar.

Mental Fitness

I rarely challenge my brain by learning something new.
I spend more than 4 hours daily on passive screen time.
I seldom read books, solve puzzles, or practice mentally stimulating activities.

Social& Emotional Health

I often feel isolated or lonely.
I rarely spend meaningful time with friends or family.
My stress feels difficult to manage most days.

Risk Factors

I have a family history of Alzheimer’s disease or dementia.
I smoke or regularly use nicotine products.
I drink alcohol excessively.
I have not had routine blood work or a wellness exam within the past year.

Remember: Your brain is remarkably adaptable throughout life. Research shows that consistent improvements in sleep, physical activity, nutrition, stress management, and cardiovascular health can support memory, focus, and overall cognitive function. Progress doesn’t require perfection—it starts with one healthy habit at a time.

Disclaimer: This checklist is an educational self-assessment and is not intended to diagnose dementia or any medical condition. If you are experiencing significant or worsening memory changes, speak with your healthcare provider for a comprehensive evaluation.