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Click ‘Get Form’ to open the dementia checklist printable in the editor.
Begin by filling out the 'Completed by' section with your name and the date of completion. This helps track who is providing the information.
In the 'Judgment' section, assess your loved one’s behavior by marking how often they forget names, mismanage money, or dress inappropriately. Use the options: Daily, Weekly, Monthly, or Never.
Proceed to the 'Communication' section. Note any difficulties your loved one has with expressing needs or engaging in conversation. Again, select from Daily, Weekly, Monthly, or Never.
Continue through each section—'Engagement', 'Bathing and Grooming', 'Toileting', 'Physical', 'Nutrition and Hydration', 'Behavior', and 'Wandering and Safety'—marking observations as appropriate.
Finally, ensure you complete the caregiver's relationship to the patient and provide a contact phone number for follow-up communication.

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What does early onset dementia look like?

The Self-Administered Gerocognitive Exam (SAGE) is a brief self-administered cognitive screening instrument used to identify mild cognitive impairment (MCI) from any cause and early dementia.

Is there a dementia checklist?

Completing the dementia symptoms checklist The checklist contains 20 questions about possible symptoms or behaviours relating to dementia. You will need to think about: the symptoms that each question describes. how long they have been happening.

What is the 30 questions test for dementia?

The Folstein Mini‐Mental State Examination (MMSE) is a 30‐question assessment of cognitive function that evaluates attention and orientation, memory, registration, recall, calculation, language and ability to draw a complex polygon (Folstein 1975).

What are the odd behaviors of dementia patients?

increased agitation. aggression (shouting or screaming, verbal abuse, and sometimes physical abuse) delusions (unusual beliefs not based on reality) hallucinations (hearing or seeing things that do not exist)

dementia checklist pdf

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