Table of Contents
- Wash hands
- Introduce self
- Ask Patient’s and relative’s names
- Explain the need for a collateral history
- Establish their relation to the patient
- 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
- 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
- Blood pressure/diabetes medication
- Parkinson’s drugs
- Alzheimer’s drugs: galantamine, donepezil, rivastigmine
- New medications
- Related conditions, e.g. dementia, vascular disease, depression
- Living situation, carer/home support
- Mobility/walking aids
- Effect on function/coping with activities of daily living: washing, dressing, cooking, cleaning
- Smoking, alcohol and other cardiovascular risk factors
- 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
- 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
Why don’t you test your knowledge?
What are the defining clinical features of delirium?
What are the possible causes of delirium?
How would you assess a patient’s capacity?