Per caregivers, the patient has been experiencing the following dementia-related symptoms:
[checkbox name="delusions" value="persecutory delusions|delusional beliefs that others are stealing|delusional beliefs that others are planning to harm in some way"]
[textarea name="descrDel" default="-"][checkbox name="hallucinations" value="visual hallucinations|auditory hallucinations"]
[textarea name="descrHall" default="-"] [checkbox name="agitation" value="agitated behaviors|resistance to help from others|uncooperative with care|uncooperative with medications|resistance to redirection|episodes of verbal aggression|episodes of physical aggression|threatening behaviors|combativeness"]
[textarea name="descrag" default="-"] [checkbox name="geriatricmood" value="depressed mood|sad mood|low mood|dysphoric mood"]
[textarea name="descrgermood" default="-"] [checkbox name="geranx" value="increased anxiety|becomes upset when separated from caregiver|signs of nervousness such as:|shortness of breath|sighing|being unable to relax|muscle tension|tense facial expressions"] [checkbox name="variable_1" value="option A|option B|option C"] [checkbox name="variable_1" value="option A|option B|option C"] [checkbox name="variable_1" value="option A|option B|option C"] [checkbox name="variable_1" value="option A|option B|option C"]
Include severity of symptom to patient and distress that symptom causes caregiver
1. Delusions: Does the patient believe that others are stealing from him/her or planning to harm him/her in some way__.
2. Hallucinations: Does the patient hearing voices or does he/she talk to people who are not there__.
3. Agitation/Aggression: Is the patient stubborn or resistive of help from others__.
4. Depression/Dysphoria: Does the patient act as if he/she were sad or in low spirits__.
5. Anxiety: Does the patient become upset when separated from you__. Does he/she have any other signs of nervousness such as shortness of breath, sighing, being unable to relax, or feeling excessively tense__.
6. Elation/Euphoria: Does the patient appear to feel too good or act excessively happy__.
7. Apathy/Indifference: Does the patient seem less interested in his/her usual activities and in the activities and plans of others__.
8. Disinhibition: Does the patient seem to act impulsively, for example, talking to strangers as if he/she knows them, or saying things that may hurt people's feelings__.
9. Irritability/Lability: Is the patient impatient and cranky__. Does he/she have difficulty coping with delays or waiting for planned activities__.
10. Motor Disturbance: Does the patient engage in repetitive activities such as pacing around the house, handling buttons, wrapping string, or doing other activities repeatedly__.
11. Nighttime behaviors: Does the patient awaken you during the night, rise too early in the morning, or take excessive naps__.
12. Appetite: Has the patient lost or gained weight, or had a change in the type of food he/she likes__.