What history is important in evaluating a patient with perceived memory loss?

Key History in Evaluating a Patient with Perceived Memory Loss

The cornerstone of evaluating a patient with perceived memory loss is obtaining a comprehensive description of cognitive and behavioral symptoms from both the patient and a reliable informant, as differences in perception provide valuable diagnostic information. 1

Initial Assessment Approach

• 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, 2
• Consider interviewing the patient and informant separately to encourage honest reporting, as diminished insight is common in cognitive impairment 1, 2
• Acknowledge upfront that disagreements between patient and informant perspectives are useful diagnostic clues 1
• Obtain corroborative history from a reliable informant, which has significant prognostic value 1, 2, 3

Specific Cognitive Symptoms to Explore

• Ask for specific examples when patients report "memory loss" or "confusion," as these terms may mean different things to patients than to clinicians 1, 2
• Explore difficulties with learning and recalling newly acquired information and recent life events (episodic memory), which are typical in Alzheimer's disease 1
• Inquire about word-finding difficulties, problems with attention, geographic disorientation, or difficulties performing step-by-step tasks 1, 2
• Assess other cognitive domains beyond memory: executive functions (reasoning, problem-solving), language (naming, fluency), visuospatial skills, and attention 1, 2

Temporal Course and Impact

• Determine when symptoms first appeared and how they have evolved over time in frequency, duration, and intensity 1, 2
• Ask about the impact on daily function, interpersonal relationships, and comportment 1
• Inquire about changes in instrumental activities of daily living (managing finances, medications, transportation, household tasks) 2, 4
• Assess for mild functional impairment for complex tasks while basic activities of daily living remain preserved 1

Associated Symptoms and Medical History

• Explore behavioral or mood-related symptoms that may be early features of neurodegenerative disease 1, 2
• Inquire about depression, anxiety, delusions, hallucinations, agitation, or obsessive-compulsive behavior 1, 2
• Ask about vascular risk factors: history of stroke, TIA, hypertension, hyperlipidemia, diabetes 2, 5
• Review all medications, including over-the-counter preparations, as certain medications can contribute to cognitive symptoms 2, 5

Questions Specifically for Informants

• Ask how long the informant has known the patient and how frequently they interact 2, 3
• Inquire about specific examples of memory lapses or cognitive difficulties the informant has observed 2, 3
• Ask about any decrease in self-care or unexplained decline in daily activities 2, 4
• Note that informant reports are more strongly predictive of cognitive impairment than subjective symptoms reported by the patient 1, 3

Longitudinal Assessment

• Obtain longitudinal assessments of cognition whenever possible, as evidence of progressive decline provides additional diagnostic information 1
• Consider using validated cognitive screening tools such as the MoCA, MMSE, Mini-Cog, or AD8 1, 2
• Schedule follow-up visits every 6-12 months to track changes over time 1, 2

Common Pitfalls to Avoid

• Don't focus exclusively on memory; assess other cognitive domains including executive function, language, and visuospatial abilities 1, 2
• Avoid attributing cognitive symptoms solely to depression or anxiety without thorough evaluation 2, 4
• Be aware that patients with cognitive impairment may have diminished insight into their condition 1, 2
• Don't rely solely on the patient's self-report; informant history is essential for accurate assessment 1, 3