The Subjective Cognitive Decline Questionnaire (SCD-Q)

Informed Consent Form for Online Screening Survey
IRBNet #: 1949579-2

We would appreciate your willingness to share your recent experiences of cognitive or memory decline as part of the StrongerMemory program. The following is the Subjective Cognitive Decline Questionnaire (SCD-Q), which includes a concise set of questions regarding recent cognitive decline. This brief survey should take 10 minutes or less. your individual answers will not be shared. Thank you for your participation.


The purpose of this survey is to determine whether you are eligible to participate in our research project. The study is limited to participants aged 60 and older who have experienced a recent decline in cognitive function. The SCD-Q is a self-administered questionnaire that asks about recent cognitive decline. You will be required to answer 24 questions with yes or no answers, and it will take you less than 10 minutes to complete the survey. All personal identifiers will be removed from these data. Those who are not selected to participate or do not pass the screener will have their data removed/destroyed.


It is not expected that you will be exposed to any risk by answering this survey. The questions will not involve any sensitive information and, therefore, should not cause any discomfort to you


You will probably not get any benefit from answering the questions, however, your answers will assist us in determining who is eligible for our study.


The information collected in this study will be kept confidential. We will remove all personal identifiers from the survey data after screening. While it is understood that no computer transmission can be perfectly secure, reasonable efforts will be made to protect the confidentiality of your transmission. The de-identified data could be used for future research without additional consent from participants. The Institutional Review Board (IRB) committee that monitors research on human subjects may inspect study records during internal auditing procedures and are required to keep all information confidential.


Your participation is voluntary, and you may withdraw from the survey at any time and for any reason.


This research is being conducted by Dr. Hyun Kang, Dr. Emily Ihara and Dr. Catherine Tompkins at George Mason University. Dr. Kang may be reached at or 703-993-7018 for questions or to report a research-related problem. You may contact the George Mason University Institutional Review Board office at 703-993-4121 or if you have questions or comments regarding your rights as a participant in the research.


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