Specific difficulties: Onset: Impact on daily activities: Worsening factors: Treatments tried: ,
Activities of Daily Living (ADL):
- Ability to bathe: - Ability to dress: - Ability to eat: - Ability to move: - Toileting: Instrumental Activities of Daily Living (IADL):
- Meal preparation: - Housekeeping: - Shopping: - Financial management: - Medication management: - Telephone use: - Transportation:
General appearance:
Heart: ,
Lungs: ,
Abdomen: , , , - Mental status: , oriented in , speech - Cranial nerves:
- Strength: upper extremities -R /5 , -L /5 lower extremities -R /5 , -L /5 - Sensation: upper extremities -R , -L , lower extremities -R , -L
- Reflexes: triceps -R , -L , biceps -R , -L , brachioradialis -R , -L
patellar -R , -L , achilles -R , -L , plantar -R , -L
- Cerebellar function: , finger-nose , rapid alternating movements , heel-knee , Romberg , Dix-Hallpike , - Gait: , tandem walking , heel and toe walking
Mental status: , , speech , mood , thought process , , judgment
- Blood work: , , , , , , , , , ,
- Neuropsychological evaluation
- Lumbar puncture if infection or prion disease suspected
- Psychoeducation about neurocognitive disorders
- Regular physical exercise
- Regular sleep schedule
- - - Home safety assessment
- Further information to obtain from family
- Referral to geriatrician
- Referral to neurologist
- Referral to social worker
- Return if symptoms worsen or if new symptoms develop such as confusion, memory loss, or changes in behavior or mood