Dementia Pathways. For Primary Care in ireland
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Patient History

History is key to the diagnosis and may require several consultations to fully gather.

Leave questions open ended initially     

  • In what way… what were you like before…
  • Give me examples…
  • When did it start…
  • How has it progressed…
  • How is your mood…

 

Questions could focus on whether the patient is experiencing any of the following:

Memory loss

 

While its normal to occasionally forget appointments, names or telephone numbers, those with dementia will forget such things more often and not remember them later

 

Difficulty performing familiar tasks

 

For example, steps for preparing a meal, using a household appliance, participating in a lifelong hobby

 

Problems with language

 

Forgets simple words or substitutes unusual words, making his or her speech or writing hard to understand.

 

Disorientation to time and place

 

For example, getting lost on their own street, forgetting where they are and how they got there, and not knowing how to get back home.

 

Poor or decreased judgment.

 

Individuals with dementia often show poor judgment about money.

 

Problems with abstract thinking

For example, difficulty balancing a check-book

 

Misplacing things

 

Such as putting things in unusual places: an iron in the freezer or a watch in the sugar bowl.

Changes in mood or behaviour

Such as, rapid mood swings for no apparent reason.

Changes in personality

 

For example, being suspicious, fearful, or dependent on a family member

Loss of initiative

 

For example, being uncharacteristically passive, sitting in front of the television for hours, sleeping more than usual, or not wanting to do usual activities.

 

Collateral History

Collateral is essential: "Do you mind if I talk to your partner/daughter etc?"

Review original history especially with regards onset and progression. Ask about any problems with the following:

  • Repetitive questions?
  • Remembering appointments, family occasions?
  • Writing cheques, paying bills, balancing the chequebook?
  • Shopping independently?
  • Taking medications according to instructions?
  • Getting lost while walking or driving in familiar places?
  • Mood / Socially withdrawn?

 

If responses are unclear ask focused questions:

  • Would he/she mange to cook a meal for the family?
  • Would you be happy to go away and leave him/her manage alone for 2 weeks- why/ why not?