A simple questionnaire of 12 questions is used at the University Hospital Groningen for evaluating amnesia following head trauma. This can be used to monitor the patient over time. The authors are from the University Hospital Groningen in The Netherlands.


Post-traumatic amnesia involves the interval from injury to the time that the patient has continuous memory for ongoing events.


Testing schedule: morning day 1, afternoon day 1, morning day 2, afternoon day 2



(1) your birthday

(2) your year of birth

(3) kind of building currently in (hospital)

(4) current place (city or town)

(5) reason for admission

(6) name of current year

(7) name of current month

(8) name of current day

(9) current time

(10) what was served for breakfast

(11) names of recent visitors, OR activity done earlier this today

(12) my (interviewer's) name



(1) orientation to person/self: 1 and 2

(2) orientation to place: 3, 4 and 5

(3) orientation to time: 6, 7, 8 and 9

(4) short term memory: 10, 11, 12


The number of correct and incorrect responses are tallied.


total number of correct or appropriate answers =

= SUM(correct responses for all 12 questions)



• minimum score: 0

• maximum score: 12

• A person with a score of 12 was considered to have recovered from any post-traumatic amnesia.


To read more or access our algorithms and calculators, please log in or register.