- Dementia Screening
III. Questions: Part 1
- Remember Name and Address (first name, last name, street number, street name, city)
- Say the info and allow patient to repeat it up to 4 times to commit to memory
- Give the exact date (month, day, year) (1 point)
- Clock Drawing Test (place 3,6,9, and 12 on clock face) (1 point)
- Draw clock with two hands showing 11:10 (1 point)
- Tell me something that happened in the news in the last week (1 point)
- Recall all 5 components of the name and address (5 points total - 1 point each)
IV. Interpretation: Part 1
- Score <5: Dementia
- Score 5-8: Intermediate (Distinguish with Part 2 Questions below)
- Score 9-10: Normal
V. Questions: Part 2 (Indicated for intermediate result in Part 1)
- Questions asked of a person who has known the patient for at least 5 years
- Questions are asked with the perspective of "compared with a few years ago"
- Answers for each question are: Yes, No, Don't Know, N/A
- Patient have more trouble remembering things that have happened recently?
- Patient have more trouble remembering conversations a few days later?
- Patient have more difficulty finding the right word or using the wrong word when speaking?
- Patient less able to pay bills, budget, manage money and other financial affairs?
- Patient less able to manage medications independently?
- Patient need more assistance with transportation?
VI. Interpretation: Part 2
- Score one point for each "No" answered in Part 2
- Add score from Part 2 to Part 1 result (maximum: 15 points)
- Score of 10 or less indicates further evaluation needed for Dementia