| __ | Memory problems |
| __ | Confusion |
| __ | Difficulty with attention |
| __ | Difficulty with concentration |
| __ | Problems with vision or hearing |
| __ | Impulsivity |
| __ | Irritability/Trouble getting along with others |
| __ | Problems with judgement |
| __ | Problems with insight |
| __ | Difficulty with reading, writing, math |
| __ | Problems with speech |
| __ | Problems with language |
| __ | Difficulty with problem solving |
| __ | Difficulty with sleeping |
| __ | Difficulty with eating |
| __ | Problems with balance |
| __ | Problems using arm(s) and leg(s) |
