Memory Problems

Reports Difficulty remembering recent events Difficulty remembering recent conversations Difficulty learning new information Difficulty recalling known information Difficulty with familiar tasks Frequently misplacing items Getting lost in familiar places Repeating questions in a short period Repeating stories in a short period

Has No difficulty remembering recent events No difficulty remembering recent conversations No difficulty learning new information No difficulty recalling known information No difficulty with familiar tasks Not been frequently misplacing items Not been getting lost in familiar places Not been repeating questions in a short period Not been repeating stories in a short period

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Complaining of Difficulty making decisions Difficulty following instructions Confusion about time/place Trouble finding words Trouble forming sentences Reduced concentration Reduced ability to focus Labile mood Anxiety Suspicion of others Fearfulness

Reports No difficulty making decisions No difficulty following instructions No confusion about time/place No trouble finding words No trouble forming sentences No reduced concentration No reduced ability to focus No mood lability No anxiety Not suspicious of others Not fearful

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Reports Tremors in Rt hand Tremors in Lt hand Tremors in both hands Slowed movement Stiffness/rigidity in arms Stiffness rigidity in legs Poor balance Difficulty walking Shuffling when walking Decreased sense of smell Difficulty with writing Difficulty with fine motor tasks Low/soft voice Expressionless face

Reports No tremors in Rt hand No tremors in Lt hand No tremors in both hands No slowed movement No stiffness/rigidity in arms No stiffness/rigidity in legs Good balance No difficulty walking No shuffling when walking Normal sense of smell No difficulty with writing No difficulty with fine motor tasks Normal voice Normal facial expression

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Red Flag Symptoms

Reports Sudden onset of memory loss Rapid decline in cognitive function Disorientation in familiar places Inability to recognize close family and friends Loss of motor skills Slurred speech Severe confusion or disorientation Hallucinations Personality changes Loss of consciousness

Reports Gradual onset of memory loss Gradual decline in cognitive function No disorientation in familiar places No inability to recognize close family and friends No loss of motor skills No slurred speech No severe confusion or disorientation No hallucinations No personality changes No loss of consciousness

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Has a history of Dementia Alzheimer’s Parkinson’s Brain tumors Stroke Traumatic brain injury

Has no history of Dementia Alzheimer’s Parkinson’s Brain tumors Stroke Traumatic brain injury

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Is currently on Antianxiety drugs Statins Anti-epileptics Antidepressants Narcotic painkillers Parkinson’s drugs Antihypertensives Sleeping aids Antihistamines

Is not currently using Antianxiety drugs Statins Anti-epileptics Antidepressants Narcotic painkillers Parkinson’s drugs Antihypertensives Sleeping aids Antihistamines

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Reports Chronic stress Anxiety Alcohol abuse Sleep deprivation History of substance abuse

Has no history of Chronic stress Anxiety Alcohol abuse Sleep deprivation Substance abuse

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