Adult Changes in Thought Study

ACT Form 73 Summary

Data Description

ACT Form 73 collects self-reported memory and functioning information on ACT participants. A high-level overview of the content areas is shown below.

Physical Functioning

Do you have difficulty with the following, and if so, how much difficulty and for how long?

Activities of Daily Living (ADLs)

  • Walking around in your house
  • Getting out of a bed or chair
  • Feeding yourself (holding a fork, cutting food, or drinking from a glass)
  • Dressing yourself (buttons, zippers, tying shoes)
  • Bathing or showering
  • Getting to or using the toilet

Instrumental Activities of Daily Living (IADLs)

  • Shopping for personal items
  • Preparing meals
  • Managing your money such as paying bills, writing checks, etc.
  • Using the telephone
  • Light housework or tidying up

Other Physical Activities or Tasks

  • Walking ½ mile
  • Walking up a flight of stairs (about 10 steps)
  • Heavy work like washing the car or raking leaves
  • Lifting or carrying something as heavy as ten pounds
  • Reaching out and above your heads with your arms
  • Gripping small objects with your hands

Psychosocial Health

For each of the following statements, choose one of the responses (definitely true, probably true, probably false, definitely false, unknown / refuse):

  • When I feel lonely, there are several people I can talk to
  • I often meet or talk with family or friends
  • If I needed help, I could easily find someone to help me with my daily chores
  • When I need suggestions on how to deal with personal problem, I know someone I can turn to
  • There is at least one person I know whose advice I really trust
  • If I had to go out of town for a few weeks, it would be possible to find someone who would look after my house or apartment (plants, pets, garden, etc.)

Memory Changes 

For each of the following questions, choose one of the responses (definitely improved, slightly improved, no change, slightly deteriorated, definitely deteriorated, don’t know):

  • Do you think your ability to remember the names of people you have just met has changed in the past 10-20 years?
  • Do you think your ability to remember the faces of people you’ve just met has changed?
  • Do you think your ability to remember the names of close friends or relatives has changed?
  • Do you think your ability to remember appointments correctly has changed?
  • Do you think your ability to judge the passage of time, and guess the time of day without looking at a clock or the sun, has changed?

 

Important Note: Form contents have changed over the years so all the above items may not be collected over the full duration of the ACT study. 

Data Structure 

This Form 73 dataset contains one row per visit at which the study form was collected. 

 

Historical Data Collection Forms

For Baseline and Biennial Visits (PDFs)