Chronic Dementia

The approach to chronic dementia is to first obtain examples of the deficits to understand which of the 6 cognitive domains it affects. Then, understand how it affects the patient’s life (morbidity) and the workup that has been done so far. Finally, with this information, you can ask more directed questions to assess for an underlying disorder.

6 Cognitive Domains (DSM-V Neurocog Disorders Criteria)

Language: word-finding difficulties, using wrong words or phrases, grammatical errors, difficulty understanding speech of others, difficulty understanding written material

Learning and Memory: difficulty recalling recent events, repeating self, misplacing objects, losing track of actions already performed, increasing reliance of lists and/or reminders

Perceptual-motor/visuospatial: poor sense of direction, getting lost in the home and other familiar places, getting lost while driving familiar routes, relying on maps/GPS for directions, bumping into objects, misjudging distances/getting into car accidents, difficulty using familiar appliances

Executive: difficulty with multi-stage tasks, planning, organizing, multi-tasking, following directions, making decisions, keeping up with rapidly shifting conversations

Complex Attention: normal tasks take longer, especially when there are competing stimuli present, easily distracted, tasks need to be simplified, difficulty holding information in mind to perform calculations or dial a phone number

Social Recognition: disinhibition or apathy, loss of empathy, inappropriate behavior, poor insight, poor judgement

Treatment History
Current outpatient neurologist: _______
Date of last outpatient visit: _______
Date of diagnosis: _______
Type of dementia

Alzheimer’s

Vascular Dementia

Lewy Body Dementia

Parkinson’s

Frontotemporal Dementia

Alcohol-related Dementia

Chronic Traumatic Encephalopathy

HIV-associated Dementia

Mixed Dementia

Other

Medication adjustments made at last outpatient visit

Previous dementia medications tried

Current dementia medication regimen

Polypharmacy screen done this appointment

Medication Side Effects Experienced

Morbidity
Where does the patient currently reside: _______

Able to perform ADLs

Able to perform IADLs

Who assists the patient with ADLs (family, health aide, etc.): _______
Highest education attained

None

Elementary School

Middle School

Some High School

Graduated High School

Some college

Graduated college

Masters or higher

Currently employed

Issues with job performance

Currently driving

Requires walking aide for ambulation

Has experienced falls (frequency and severity)

Prior Workup

Prior brain imaging

Prior EEG

Prior LP

Prior neuro-psychologic testing

Bedside cognitive testing (MOCA, SAGE, MMSE)

Speech therapy (cognitive assessment)

Determining Underlying Etiology

Behavioral Changes

New or worsening depression, anxiety, or psychosis (limbic encephalitis, dementia with behavioral disturbance, pseudo-dementia)

Socially inappropriate laughter/crying (pseudobulbar affect)

Change in personality/impulsivity or inappropriate behavior (FTD, behavioral variant)

Magnetic gait, urinary changes, psychomotor slowing (NPH)

Speech Changes

Reduced spontaneous verbal output with grammatical errors (FTD, primary progressive aphasia agrammatic variant)

Loss of word meaning with fluent speech (FTD, primary progressive aphasia semantic variant)

Associated Symptoms

Past Medical History

Hx of head trauma or contact sports (CTE)

Vascular risk factors or strokes (vascular dementia)

Sexually active, hx of STI (HIV, neurosyphilis)

Witnessed seizure or aura-like episodes (late adult-onset epilepsy)

Choking/gasping for air during sleep, excessive daytime sleepiness (OSA)

Tobacco, drug, or alcohol use

Family history of dementia, parkinsonism, or other neuro condition

Medication-Induced

Benzodiazepines

Anti-cholinergics

Opiates

Other

Chronic Dementia

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