Transcription of DEMENTIA FUNCTIONAL ASSESSMENT TOOL
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DEMENTIA FUNCTIONAL ASSESSMENT TOOL
DEMENTIA FUNCTIONAL ASSESSMENT tool . I NAME: LEVEL CLINICAL CHARACTERISTICS DATE DATE DATE DATE. 1 2 3 4. 1 .. EarlyStage No demonstrated memorydeficits No Cognitive NOsubiective cases of memolYdeficits Decline FunctionsindeoendentIY. 2 - Early Stage Very Mild Subjective cases of memorydeficits(placement of familiarobjects, names he/she knows well). Cognitive Decline No problems completingtasks or at social functions (FOrgetfulness). - 3 Middle Stage Mild Cognitive Memorvdeficitevident on intensive interview Attemots to conceal deficits Decline Exoresses concem reaardina deficits (mildlmoderateanxietY). (EarlyConfusional) Problems oerforminain demancfU1Q situations {workor socian 4 -Middle Stage Moderate Decreased knowledae of current and recent events Memorvdeficitsreaardina oelSOnalhistorY.}
DEMENTIA FUNCTIONAL ASSESSMENT TOOL I NAME: DATE SIGNATURE OF PERSON(S) COMPLETING ASSESSMENT PER REVIEW LEVEL CLINICAL CHARACTERISTICS DATE DATE DATE DATE 1 2 3 4 1 ...
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