Key Questions for Assessing Patients with Memory Complaints
When evaluating a patient who reports poor memory, clinicians should conduct a structured assessment that includes specific questions about cognitive symptoms, their impact on daily functioning, and corroborative information from an informant whenever possible. 1
Initial Assessment Questions
- Begin with an open-ended question: "What is the main reason you are here to see me and what would you like to accomplish from the visit today?" 1
- Explain that it's helpful to hear perspectives from both the patient and their companion, as differences in perception can provide valuable diagnostic information 1
- Consider interviewing the patient and informant separately to encourage honest reporting 1
Specific Questions About Memory Symptoms
- Ask for specific examples of memory difficulties, as terms like "memory loss" may mean different things to patients than to clinicians 1
- Inquire about difficulties with learning and recalling newly acquired information and recent life events (episodic memory) 1
- Ask about word-finding difficulties, problems with attention, geographic disorientation, or difficulties performing step-by-step tasks 1
- Determine the characteristics, intensity, temporal course, and impact of symptoms 1
Questions About Functional Impact
- Ask about changes in instrumental activities of daily living (managing finances, medications, transportation, household tasks) 2
- Inquire about missed appointments, showing up at incorrect times, difficulty following instructions or taking medications 1
- Ask about any decrease in self-care or unexplained decline in daily activities 1
- Determine if there has been any victimization by financial scams 1
Questions About Onset and Progression
- When did the memory problems first begin? 1
- How have the symptoms evolved over time in frequency, duration, and intensity? 1
- Were the symptoms episodic or ever-present but became more noticeable? 1
- Were there any triggering events (surgery, trauma, illness) that coincided with symptom onset? 1, 3
Questions About Associated Symptoms
- Ask about changes in mood, including new onset of depression or anxiety 1
- Inquire about changes in personality or behavior 2
- Ask about gait problems, tremor, balance issues, swallowing difficulties, or incontinence 1
Questions About Medical History
- Inquire about vascular risk factors: history of stroke, TIA, hypertension, hyperlipidemia, diabetes 1
- Ask about sleep disorders, particularly untreated sleep apnea 1
- Inquire about recent head injury 1
- Ask about Parkinson's disease or other neurological conditions 1
- Review all medications, including over-the-counter preparations 1, 3
Questions for the Informant
- How long have you known the patient and how frequently do you interact? 1
- Have you noticed changes in the patient's memory or thinking abilities? 1, 2
- Are there specific examples of memory lapses or cognitive difficulties you've observed? 1
- Have you noticed changes in the patient's ability to perform everyday activities? 2, 4
- Have you observed changes in personality, mood, or behavior? 2
Common Pitfalls to Avoid
- Don't dismiss memory complaints in older adults as "normal aging" without proper evaluation 1, 5
- Be aware that patients with cognitive impairment may have diminished insight into their condition 1, 6
- Remember that informant reports provide added value to patient history in cases of neurodegenerative disorders 1
- Don't focus exclusively on memory; assess other cognitive domains including executive function, language, and visuospatial abilities 1, 2
- Be cautious about attributing cognitive symptoms solely to depression or anxiety without thorough evaluation 3