What questions should be asked to a patient expressing concerns about their memory?

Key Questions to Ask Patients with Memory Concerns

When evaluating a patient with memory concerns, clinicians should ask specific questions about the nature, impact, and timeline of cognitive symptoms, while also involving an informant whenever possible to gain additional perspective. 1, 2

Initial Assessment Questions

Opening Questions

• "What is the main reason you are here to see me and what would you like to accomplish from the visit today?" 1
• "Can you tell me more about your memory concerns?" 1
• "When did you first notice these changes in your memory?" 1

Specific Memory Symptom Questions

• "Can you give me specific examples of memory problems you've experienced?" 1
• "How often do these memory problems occur?" 1
• "Have these problems been getting worse, staying the same, or improving over time?" 1
• "Do you have trouble remembering recent events or conversations?" 2
• "Do you have difficulty learning and recalling new information?" 1
• "Do you find yourself repeating questions or statements?" 2

Functional Impact Questions

• "Have these memory problems affected your daily activities?" 1, 2
• "Do you have difficulty managing medications?" 1
• "Have you missed appointments or shown up at incorrect times?" 1
• "Has there been any change in your ability to:
  • Manage finances or bills?
  • Drive or navigate familiar routes?
  • Follow recipes or instructions?
  • Use technology you were previously comfortable with?" 2

Questions for Informants

Involving an informant (family member or close friend) is crucial as patients may lack insight into their cognitive changes 1. Consider interviewing the patient and informant separately when appropriate 1.

• "Have you noticed any changes in their memory or thinking?" 1
• "When did you first notice these changes?" 1
• "Have there been any changes in their personality or behavior?" 2
• "Have they had difficulty remembering recent conversations or events?" 1
• "Have you noticed any decline in their ability to perform everyday tasks?" 1, 2
• "Have they become more repetitive in questions or statements?" 2

Associated Risk Factors and Conditions

• "Have you experienced any recent head injury?" 1
• "Do you have a history of stroke or TIA?" 1
• "Do you have any history of depression or anxiety?" 1
• "Have you been diagnosed with sleep apnea?" 1
• "Do you have any cardiovascular conditions like high blood pressure or diabetes?" 1, 2
• "Have you recently been hospitalized or experienced confusion during an illness?" (to assess for delirium) 1

Important Clinical Considerations

• Be aware that patients and informants may use terms like "memory loss" or "confusion" differently than clinicians do 1
• Ask for specific examples to clarify what they mean by memory problems 1
• Acknowledge that patient and informant perspectives may differ, and frame this as helpful information rather than a disagreement 1
• Recognize that patients often attribute memory changes to specific events (surgery, trauma) that may not be the actual cause 1
• Be mindful that anxiety can affect memory recall and should be assessed 2, 3

Next Steps After Assessment

If clinically significant memory concerns are identified, proceed with validated cognitive assessment tools such as:

• Mini-Cog (2-3 minutes) 2
• Montreal Cognitive Assessment (MoCA) (10-15 minutes) 2
• Memory Impairment Screen (MIS) + Clock Drawing Test (CDT) 1
• AD8 (informant questionnaire) 1, 2

A score below established cutoffs on these screening tools warrants further evaluation including laboratory testing, neuroimaging, and possibly referral to a specialist 2.

Remember that routine screening of asymptomatic individuals is not recommended, but clinicians should remain vigilant for warning signs of cognitive disorders in older adults 1.