canadian study of health and aging
Canadian Study of Health and Aging
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Risk Factor Questionnaire

Information on risk factors was collected in two ways. As the memory problems of dementia prevent patients from providing accurate information, questionnaires were administered to a person who knew the subject well (typically, the spouse or other family member). This was done for people with dementia at CSHA-1, and also for a random sample of controls who were clinically examined and confirmed to be cognitively normal.

In addition, at the CSHA-1 baseline, 6,628 participants who were found to be cognitively normal completed a risk factor questionnaire themselves. This was used in the cohort risk factor study which was undertaken using incident cases identified at the CSHA-2 follow-up study.

Content of the CSHA Risk Factor Questionnaires:

Data Collected
Date & place of birth
Marital status, education, ethnic origin
Residential History
Countries and towns lived in; dates
Water sources used
Occupational History
Jobs held: title, industry, dates
Gardening, painting, automotive
Home or furniture repairs
Contact sports, camping, boating
Occupational or Hobby Exposures
Dyes, paints, fuels, oils, solvents, glues
Pesticide, herbicide or fertilizer use
Excessive noise
Family Structure
Age of parents at subject’s birth
Siblings, children, twin?
Health History
Chronic conditions
Mental problems
Head injuries
Operations and anesthetics
Medication use
Family history
Selected chronic conditions
Use of antacids, analgesics, anti-perspirants
Use of alcohol, tobacco, selected nutritional items
Physical activity level


Click here to download the Risk Factor Questionnaire (PDF format 2.9MB)
Click here to download the Risk Factor Questionnaire (PDF format 2.9MB)

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