From the Guidelines
When evaluating a patient with forgetfulness, it is crucial to ask about the specific memory problems they're experiencing, including when symptoms began, progression over time, and impact on daily functioning, as this information is essential for distinguishing between normal aging, mild cognitive impairment, dementia, or other conditions causing memory problems 1. To gather this information, clinicians should use a comprehensive and structured approach, including validated clinical assessment instruments, to compile a history of cognitive or behavioral symptoms, as recommended by the Alzheimer's Association clinical practice guideline 1. Some key questions to ask include:
- When did the symptoms start, and how have they progressed over time?
- What specific memory problems are they experiencing, such as difficulty learning new information or recalling recent events?
- How do these symptoms impact their daily functioning, including their ability to manage finances, medications, transportation, and household tasks?
- Are there any associated symptoms, such as personality changes, language difficulties, disorientation, or problems with judgment?
- What is their medical history, including conditions like stroke, head trauma, thyroid disease, vitamin B12 deficiency, and depression?
- What medications are they currently taking, as some can cause cognitive impairment?
- Are there any risk factors, such as family history of dementia, alcohol use, and sleep patterns? A thorough cognitive assessment should be performed using standardized tools like the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA), as these can help identify cognitive impairment and distinguish between different conditions 1. It is also essential to consider the patient's own meaningful health outcome goals and care preferences, as well as their ability to perform routine tasks independently, when evaluating their cognitive function 1. By asking these questions and using a comprehensive and structured approach, clinicians can gather the necessary information to make an accurate diagnosis and develop an effective treatment plan, which can help improve the patient's quality of life and reduce morbidity and mortality 1.
From the Research
Questions to Ask in Patients with Forgetfulness
When assessing a patient with forgetfulness, it is essential to ask questions that cover various cognitive domains. The following are some key areas to focus on:
- Memory: Ask questions about recent and remote memory, such as recalling recent events or memories from the past 2
- Language: Assess language skills, including comprehension, expression, and repetition 2
- Executive function: Evaluate planning, set-shifting, and problem-solving abilities 2
- Visuospatial functions: Assess spatial awareness, orientation, and constructional abilities 2
- Social cognition: Evaluate social awareness, empathy, and behavior 2
Additional Assessment Tools
In addition to asking questions, several standardized screening tests can be used to assess cognitive function, including:
- Montreal Cognitive Assessment (MoCA) 2
- Mini-Mental State Examination (MMSE) 2, 3
- Clock drawing test: A simple bedside test that can assess global cognitive functions, including attention, planning, and visuospatial orientation 2
- Random letter cancellation test: A test that can assess attention and distractibility 2
Identifying Triggers for Repetitive Questioning
Repetitive questioning is a common problem in patients with Alzheimer's disease, and identifying triggers can help caregivers address this issue. Some potential triggers include:
- Concerns about safety or well-being 4
- Watching violent or disturbing movies or TV shows 4
- Easy distractibility and poor attention span 4
Medication Use and Dementia Risk
Certain medications, such as anticholinergics and benzodiazepines, may increase the risk of dementia. Caregivers and healthcare providers should be aware of this potential risk and take steps to minimize it, including: