Forgetfulness

Question 1

Sequence of events

Answer 1

Open question
Timeline

Question 2

Symptom analysis

Answer 2

Short term- names, appointments, dates, medications
Long term- married, first job
Visuospatial- places, people, items
Language- finding the right words
Behaviour- change in behaviour (irritability, sexual disinhibition, wandering, social withdrawal)
Personality- any changes eg. Violence, outbursts, aggression (physical or verbal)

Question 3

Systems review

Answer 3

Psychosis- auditory hallucinations/ visual hallucinations/ altered sensations/ delusions of thought and control
Mania- energy levels/ have people said you are hyper/ spending habits/ libido
Depression- mood/anhedonia/ sleep/ future
Others- anxiety/ insight/ relationship with food
Constitutional- FWARJRLN
Parkinsonism- tremor, walking, handwriting

Question 4

Risk

Answer 4

Coping with AODL- wash, dress, prepare meals, finances etc.
Dangerous events- falls, wandering, fire
Driving- accidents
Self harm or harm to others?

Question 5

Red flags

Answer 5

Acute change in cognition
Neurological Sx
Loss of functioning
Lack of support

Question 6

Patients perspective

Answer 6

Feelings and impact
ICE
Insight

Question 7

PMH

Answer 7

Medical or physical
Hearing and visual

Question 8

DH

Answer 8

Allergies
Regulars
OTC
Remember to take them ? Does anyone see them take them?

NB- could have a station where the person has really high HTN and it’s because they aren’t taking their meds

Question 9

FH

Answer 9

Ask about memory problems

Question 10

SH

Answer 10

Job- what does it involve. Impact on job
Home situation- occupants and difficulties
How is mood affecting home life
Support from family or friends
Smoke alcohol recreational drugs
Have you been looking after yourself and the home eg. showering and cleaning

Question 11

To finish

Answer 11

Collateral history

Question 12

Alzheimer’s disease

Answer 12

Short term, then behavioural change

Question 13

Vascular dementia

Answer 13

Stepwise decline in cognitive functioning over months to years
CV risk factors
Potential stroke/TIA in history

Question 14

Dementia with Lewy bodies

Answer 14

Fluctuating confusion
Parkinsonism features, visual hallucinations, intermittent LOC
Short term memory preserved more than AD, but visuospatial difficulties more pronounced

Question 15

Fronto temporal dementia

Answer 15

Aggression, in appropriate social behaviour, emotional blunting, incontinence, speech and language difficulties all occur early
Insidious with an earlier age of onset than AD

Question 16

Other causes

Answer 16

Normal ageing

Delirium- acute and usually a reversible cause

Depression (depressive pseudodementia)- difficult in attention and concentration as well as other Sx

Metabolic disturbance- uraemia from liver or renal failure, hypothyroidism, hypo or hyper calcaemia, hypoglycaemia, vitamin B12 or folate deficiency

Brain tumour- behavioural or personality changes, headache, seizure, n and v

PD- PD Sx preceding dene tia by at least a year (different to Lewy bodies- dementia first)

Question 17

Investigations

Answer 17

Full physical examination with observations
MSE, MOCA
Bloods- FBC UE LFT TFT B12 folate bone profile glucose cultures (from 2 sites)
CXR ECG
MRI head

If needed, lumbar puncture, syphyllis serology