Active languages - Data Entry: en, hi | Survey: en, hi
[hi] ??? |
|
|
1 |
[record_id] |
Record id |
text |
|
|
2 |
[participant_id_moca] |
Participant id |
text |
|
|
3 |
[education_years] |
Is education qualification less than 12 years? |
yesno |
|
|
4 |
[participant_name] |
Participant name
प्रतिभागी का नाम
|
text |
|
|
5 |
[trail_making] |
Section Header: VISUOSPATIAL / EXECUTIVE (दृश्य-स्थानिक / कार्यकारी कार्य) 5 points
Connect the alternating numbers and letters(1 - - 2 - B - 3 - C ... )👉 Draw a line starting at 1, then go to A, then to 2, then B, and continue in alternating sequence until the task is complete.संख्या और अक्षरों को बारी-बारी से जोड़ें(1 - क - 2 - ख - 3 - ग... )👉एक रेखा खींचें, जो 1 से शुरू हो, फिर A, उसके बाद 2, फिर B, और इसी तरह क्रम में आगे बढ़ते हुए कार्य पूरा करें।
|
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
6 |
[please_copy_this_cube_draw] |
Please copy this cube drawing as precisely as you canकृपया इस घन चित्र को यथासंभव सटीक रूप से कॉपी करें |
radio |
|
|
7 |
[clock_contour] |
Section Header: Clock Drawing :
Draw a clock. Put in all the
numbers and set the time to 10 past 11(Draw 11:10)
एक घड़ी बनाएँ। सभी
संख्याएँ डालें और समय 11 बजकर 10 मिनट पर सेट करें (11:10 बनाएँ)
Clock contour (घड़ी का आकार/रूप)
|
radio |
|
|
8 |
[clock_numbers] |
Clock numbers (घड़ी के अंक) |
radio |
|
|
9 |
[clock_hands] |
Clock hands (घड़ी की सुइयां) |
radio |
|
|
10 |
[total_visuoperception_score] |
total visuoperception score |
calc
Calculation: [trail_making] + [please_copy_this_cube_draw] + [clock_contour] + [clock_numbers] + [clock_hands] |
|
|
11 |
[naming_1] |
Section Header: Identify the animals shown (if given).जानवरों की पहचान करें (यदि दिए गए हों)।
Naming (3 pts)
lion (शेर)
|
radio (Matrix) |
|
|
12 |
[naming_2] |
rhino (गैंडा) |
radio (Matrix) |
|
|
13 |
[naming_3] |
camel (ऊंट) |
radio (Matrix) |
|
|
14 |
[naming_score] |
Naming score |
calc
Calculation: [naming_1] + [naming_2] + [naming_3] |
|
|
15 |
[memory_no_immediate_scorin] |
Memory (→ No immediate scoring)
MEMORY (स्मृति)
Read the following list of words. Subject must repeat them. Do 2 trials.
निम्नलिखित शब्द पढ़ें। प्रतिभागी को उन्हें दोहराना है। दो बार दोहराएँ।
LEG (पैर), COTTON (कपास), SCHOOL (स्कूल),TOMATO (टमाटर), WHITE (सफेद)
|
dropdown| 1 | Recalled spontaneously - स्वतः स्मरण किया | | 2 | Recalled with category cue - श्रेणी संकेत के साथ स्मरण किया | | 3 | Recalled with multiple choice - बहुविकल्पीय विकल्पों के साथ स्मरण किया | | 4 | Incorrect - गलत | | 5 | No recall - कोई स्मरण नहीं |
|
|
|
16 |
[repeat_2_1_8_5_4] |
Section Header: Section 4: Attention (Total: 6 points)
Digits Forward / संख्याएँ आगे की ओर 2 4 8 1 5
|
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
17 |
[digits_backward_7_2_4] |
Digits Backward / संख्याएँ उल्टी दिशा में 7 2 4 |
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
18 |
[vigilance_task_read_letter] |
Vigilance Task / सतर्कता कार्य Read letters, tap hand at letter "A"
FABBBCCCAAAATTTERCTCHA
अक्षरों की सूची पढ़ें, "A" पर हाथ थपथपाएँ
FABBBCCCAAAATTTERCTCHA
|
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
19 |
[serial_7_subtraction_7_sta2] |
Serial 7 Subtraction / 7 घटाव क्रम Start from 60 and subtract 7 (60 → 53 → 46 → 39 → 32 → 25) |
radio| 3 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
20 |
[total_attention_score] |
Total attention score |
calc
Calculation: [repeat_2_1_8_5_4] + [digits_backward_7_2_4] + [vigilance_task_read_letter] + [serial_7_subtraction_7_sta2] |
|
|
21 |
[fluency_score] |
Section Header: Fluency / प्रवाह
Fluency / प्रवाह
Name maximum words beginning with letter "B" in 1 minute.
1 मिनट में "B" से शुरू होने वाले अधिकतम शब्द बताइए।
(Within 1 minute minumum 11 words)
|
radio |
|
|
22 |
[sentence_1_language] |
Section Header: Section 5: Language
LANGUAGE (भाषा)
Sentence 1 / वाक्य 1 👉 "I only know that John is the one to help today"
📝 हिंदी अनुवाद: "मुझे केवल यह पता है कि आज मदद करने वाला जॉन ही है।"
|
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
23 |
[sentence_2_language] |
Sentence 2 / वाक्य 2👉 "The cat always hid under the couch when dogs were in the room"
📝 हिंदी अनुवाद: "जब भी कमरे में कुत्ते होते थे, बिल्ली हमेशा सोफे के नीचे छिप जाती थी।"
|
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
24 |
[abstraction_1] |
Section 6: Abstraction (Total: 1 points)
Train & Bicycle
Question / प्रश्न:
👉 Train and bicycle are both?
👉 "रेलगाड़ी और साइकिल दोनों क्या हैं?"
|
radio| 1 | Transportation - यात्रा के साधन / परिवहन के साधन | | 0 | Incorrect -गलत |
|
|
|
25 |
[abstraction_2] |
Section 6: Abstraction (Total: 1 points)
Banana and Orange =
केला - संतरा = फल
|
radio| 1 | Fruit - फल | | 0 | Incorrect - ग़लत |
|
|
|
26 |
[section_7_delayed_recall_5] |
Section 7: Delayed Recall (5 points)
DELAYED RECALL (विलंबित स्मृति पुनःस्मरण)
Without cues, recall the 5 words:
बिना संकेत के 5 शब्द याद करें:
LEG (पैर), COTTON (कपास), SCHOOL (स्कूल),TOMATO (टमाटर), WHITE (सफेद)
|
dropdown| 5 | सही (Recalled Correct) | | 0 | ग़लत ( Recalled Incorrect) |
|
|
|
27 |
[orientation_date] |
Section Header: Section 8: Orientation (6 points)
Date (तारीख)
|
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
28 |
[orientation_month] |
Month (महीना) |
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
29 |
[orientation_year] |
Year (साल) |
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
30 |
[orientation_day] |
Day (दिन) |
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
31 |
[orientation_place] |
Place (स्थान) |
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
32 |
[orientation_city] |
City (शहर) |
radio| 1 | सही (Correct) | | 0 | ग़लत (Incorrect) |
|
|
|
33 |
[moca_total_score] |
moca_total_score |
calc
Calculation: [total_visuoperception_score]
+ [naming_score]
+ [total_attention_score]
+ [fluency_score]
+ [sentence_1_language]
+ [sentence_2_language]
+ [abstraction_1]
+ [abstraction_2]
+ [section_7_delayed_recall_5]
+ [orientation_date]
+ [orientation_month]
+ [orientation_year]
+ [orientation_day]
+ [orientation_place]
+ [orientation_city]
|
|
|
34 |
[adjusted_moca_score] |
adjusted moca score |
calc
Calculation: if([education_years] = 1, min(30, [moca_total_score] + 1), [moca_total_score]) |
|
|
35 |
[normal_26_30]
Show the field ONLY if:
[adjusted_moca_score] >= 26
|
Normal (≥26/30)
|
descriptive |
|
|
36 |
[below_normal_26_30]
Show the field ONLY if:
[adjusted_moca_score] < 26
|
Below Normal (< 26/30)
|
descriptive |
|
|
37 |
[moca_complete] |
Section Header: Form Status
Complete?
|
dropdown| 0 | Incomplete | | 1 | Unverified | | 2 | Complete |
|
Add users
Remove users
Download as Excel/CSV
Archive conversation
