Introduction

• Wash hands
• Introduce self
• Ask Patient’s and relative’s names
• Explain the need for a collateral history
• Establish their relation to the patient

Presenting complaint

• Confusion/memory loss

History of presenting complaint

• Onset: determine if it is acute, chronic, or acute-on-chronic (establish baseline function and cognition)
• Progression: slowly progressive (Alzheimer’s), step-like (vascular)
• Triggers: infection, stress
• Associated symptoms
  • Depression
  • Psychiatric symptoms: hallucinations/delusions
  • Behavioural change: agitation, aggression, wandering, disinhibition, calling out
  • Sleeping pattern: awake at night (Alzheimer’s), early morning waking (depression), fluctuating consciousness (delirium)
  • Cognitive disturbances: aphasia, apraxia, agnosia, difficulty planning/organising

Past medical history

• Ask about: Parkinson’s disease, vascular disease/diabetes, head injuries, recent infections
• Psychiatric history

Drug history

• Blood pressure/diabetes medication
• Parkinson’s drugs
• Alzheimer’s drugs: galantamine, donepezil, rivastigmine
• New medications
• Allergies

Family history

• Related conditions, e.g. dementia, vascular disease, depression

Social history

• Living situation, carer/home support
• Mobility/walking aids
• Effect on function/coping with activities of daily living: washing, dressing, cooking, cleaning
• Working/driving
• Smoking, alcohol and other cardiovascular risk factors
• RISK
  • To self: wandering, leaving gas on, abuse, neglect by self or others
  • To others: aggression, risky behaviour
• Carer’s needs: empathise with the demands; ask about stress, coping, and support

Ending

• ICE (Ideas, Concerns, Expectations): how does the relative/carer expect you to help? What are they worried about?
• Summarise situation and patient needs. Thank relative.

Causes of dementia

• Alzheimer’s: most common; prevalence increases with age; some genetic association. Slowly progressive. Presents with memory/cognitive impairment (5A’s: Anomia, Apraxia, Agnosia, Amnesia, Aphasia). Due to generalised atrophy of cortex with amyloid plaques and neurofibrillary tangles.
• Vascular Dementia: stepwise deterioration. Often have multiple cardiovascular risk factors. May have focal neurology. CT head may show areas of ischemia or small vessel disease.
• Lewy-Body Dementia: progressive dementia with daily fluctuations of awareness due to Lewy bodies in the cerebral cortex. Parkinsonian features (e.g. bradykinesia, tremor, rigidity) and psychiatric symptoms (e.g. hallucinations) are common.
• Other causes/differentials: frontotemporal lobe dementia, Creutzfeldt-Jakob disease, depression (‘pseudodementia’), HIV, Huntington’s disease, normal pressure hydrocephalus, space-occupying lesion, nutritional deficiencies (thiamine, nicotinic acid, B₁₂), alcohol abuse, neurosyphilis, hypothyroidism, autoimmune/paraneoplastic

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