TRN:____

CAMBRIDGE BEHAVIOURAL
INVENTORY
NB: This questionnaire is used in studies of a number of different diseases, and
some of the questions may not be applicable to your individual circumstances

To be completed by a person
who knows the patient well
YOUR NAME:
RELATIONSHIP TO THE PATIENT:
THE PATIENTS NAME:
DATE:

Instructions:

Please fill in the blanks above with your name, the patients name and the date.
We would like to ask you a number of questions about various changes in the
patients behaviour that you may have noticed. It is important that we obtain your
views as it will help us in our assessment.
Please read the description of each problem carefully. Then circle the number
under the heading FREQUENCY that best describes the occurrence of the
behavioural change where:
0 = never
1 = a few times per month
2 = a few times per week
3 = daily
4 = constantly
Some of the everyday skill questions may not apply, if for instance the person
you care for has never done the shopping enter N/A (not applicable)
All questions apply to the patients behaviour over the past month.

PROBLEM

FREQUENCY
How often does the patient
show the problem?

0 = never
1 = a few times per month
2 = a few times per week
3 = daily
4 = constantly

Memory

1.
2.
3.
4.
5.
6.

Forgets to pass on phone messages

Has poor day-to-day memory (e.g. about conversations, trips etc.)
Asks the same question over and over again
Loses or misplaces things
Forgets the names of familiar people
Forgets the names of objects and things

0
0
0
0
0
0

1
1
1
1
1
1

2
2
2
2
2
2

3
3
3
3
3
3

4
4
4
4
4
4

0
0
0
0
0
0
0

1
1
1
1
1
1
1

2
2
2
2
2
2
2

3
3
3
3
3
3
3

4
4
4
4
4
4
4

0
0
0
0
0
0
0

1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4

0
0
0
0
0
0
0

1
1
1
1
1
1
1

2
2
2
2
2
2
2

3
3
3
3
3
3
3

4
4
4
4
4
4
4

0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4
4

Orientation and Attention

7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.

Has difficulties completing activities once started

Shows poor concentration when reading or watching television
Forgets what day it is
Forgets what time of day it is
Gets the present mixed up with past situations
Becomes confused or muddled in unusual surroundings
Gets lost inside the house

(Not applicable)
Everyday Skills
Has difficulties using electrical appliances (e.g. TV, radio, cooker, washing machine) N/A 0

Has problems preparing meals

Has difficulties writing (letters, Christmas cards, lists etc.)
Has difficulties using the telephone
Has difficulties making a hot drink (e.g. tea/coffee)
Has difficulties shopping
Has problems handling money or paying bills
Has difficulties with household chores

N/A
N/A
N/A
N/A
N/A
N/A
N/A

Self Care
Has difficulties travelling to places by self (either by driving or on public transportation)

Has difficulties grooming self (e.g. shaving or putting on make-up)

Has difficulties dressing self
Has problems feeding self without assistance
Has problems bathing or showering self
Has difficulties using toilet by self
Wets self with urine
Mood

29.
30.
31.
32.
33.
34.
35.
36.
37.

Cries
Appears sad or depressed
Is anxious or fearful
Is very restless or agitated
Is very irritable
Has rapid shifts between different emotions
Appears inappropriately cheerful
Talks big e.g. claims more wealth than true
Finds humour or laughs at things others do not find funny
FREQUENCY
PROBLEM

0 = never

How often does the patient

show the problem?

38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.

1 = a few times per month

2 = a few times per week
3 = daily
4 = constantly

Beliefs
Is suspicious or accusative
Sees things that are not really there (visual hallucinations)
Hears voices that are not really there (auditory hallucinations)
Has odd or bizarre ideas that cannot be true
Believes that additional people are living in the house
Thinks that a family member has been replaced by an impostor
Thinks that people on the TV are actually in the room
Challenging Behaviour
Has temper outbursts
Threatens to harm self/others or property
Is uncooperative when asked to do something
Disturbs others by shouting or yelling
Disinhibition
Shows socially embarrassing behaviour
Makes tactless or suggestive remarks
Displays suggestive behaviour (e.g. touching inappropriately)
Acts impulsively without thinking
Talks to total strangers as if they know them
Eating Habits
Prefers sweet foods more than before
Wants to eat the same foods repeatedly
Her/his appetite is greater, s/he eats more than before
Table manners are declining e.g. stuffing food into mouth
Eats non-edible foodstuffs or things not normally eaten
Sleep
Sleep is disturbed at night
Sleeps more by day than before (cat naps etc.)
Stereotypic and Motor Behaviours
Is rigid and fixed in her/his ideas and opinions
Develops routines from which s/he cant easily be discouraged e.g. wanting to eat
or go for walks at fixed times
Exhibits rituals e.g. takes the same route across the kitchen, only steps on certain
floor tiles
Clock watches or appears pre-occupied with time
Appears pre-occupied with counting, numbers, puzzles or jigsaws
Takes, hides or hoards things, or packs away special items
Repeatedly uses the same expression or catch phrase

0
0
0
0
0
0
0

1
1
1
1
1
1
1

2
2
2
2
2
2
2

3
3
3
3
3
3
3

4
4
4
4
4
4
4

0
0
0
0

1
1
1
1

2
2
2
2

3
3
3
3

4
4
4
4

0
0
0
0
0

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

4
4
4
4
4

0
0
0
0
0

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

4
4
4
4
4

0
0

1
1

2
2

3
3

4
4

0
0

1
1

2
2

3
3

4
4

3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4

64.
0 1 2
65.
0 1 2
66.
0 1 2
67.
0 1 2
0 1 2
68. S/he immediately repeats words and sentences that you or others have just said (echolalia)
69. Paces around without purpose
0 1 2
70. Rummages around excessively
0 1 2
0 1 2
71. S/he fidgets (e.g. bounces, taps feet/hands) a lot
0 = never
PROBLEM
FREQUENCY
How often does the patient
1 = a few times per month

show the problem?

2 = a few times per week

3 = daily
4 = constantly

Motivation

72.
73.
74.
75.
76.
77.
78.
79.
80.
81.

Shows less enthusiasm for his/her usual interests

Shows little interest in doing new things
Requires nagging to start activities and chores
Shows no interest in attending social functions
Fails to maintain motivation to keep in contact with friends or family
Withdraws from others, fails to start conversations
Appears indifferent to the worries and concerns of family members
Shows reduced affection
Insight / Awareness
Shows insight into changes in behaviour and personality (if appropriate)
Shows insight into memory problems

0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2

3 4
3 4
3 4
3 4
3 4
3 4
3 4
3 4

0
0

1
1

2
2

3
3

____________________________________________________________________________

Thank you very much for taking the time to fill out
this questionnaire.

4
4