. Clarity AD Study

See if you may Qualify

Who are you taking this questionnaire for?  

What is your date of birth?
Month Day Year
Please select your gender:

Have you been diagnosed with either Mild Cognitive Impairment due to Alzheimer’s Disease or Mild Alzheimer’s Disease Dementia?

Below are a series of medications. Please check which medications you have taken, if any.

Do you have a history of taking any immunoglobulin therapies or biologics in the past 6 months? Some examples are:

  • Ranibizumab – Lucentis
  • Bevacizumab – Avastin
  • Infliximab – Remicade
  • Etanercept – Enbrel
  • Adalimumab – Humira
  • Omalizumab – Xolair
  • Efalizumab – Raptiva
  • Immune globulin IV

Do you currently have a cardiac pacemaker/defibrillator or have any metallic implants in the brain, eye, or ears?

If asked to do so, would you be willing to have a PET scan?

Have you experienced a stroke, seizures, or TIA (transient ischemic attacks) within the last 12 months?

Do you have any plans to undergo surgery that would require general anesthesia throughout the course of the study? As a reminder, the study lasts up to 24 months.

This study requires a study partner such as a relative, spouse, friend, or caregiver that can help the study participant meet study requirements.

The study partner does not have to live with the participant but must spend enough time with the participant (at least 8 hours a week) and be available to provide follow-up information on the participant throughout the study. The study partner must be available to attend certain study appointments with the participant, including the initial visit. The study center can review this in more detail if you pre-qualify.

Do you have a study partner that will meet these requirements?

How did you hear about us?