Dementia Self-Survey

Self-Survey for Dementia
Use the following questions to help determine if you or your loved one has mild or moderate dementia. Those with mild dementia often do better if they start treatment early. Medication can often slow down the progression of symptoms of dementia. Treatment can help keep people as independent as possible for as long as possible. However, irreversible dementia does get worse over time. It is important to know what to expect. If you or a loved one has some of these symptoms, please speak with your doctor. 

Mild Dementia (Can last two to four years or longer)
  • Memory loss?
  • Trouble finding names for common items?
  • Asking the same questions repeatedly?
  • Saying the same things over and over?
  • Getting lost easily, most often in new places?
  • Losing interest in things once enjoyed?
  • Changes in personality?
  • Often needing some support to be independent?
  • Altered sleep patterns?
  • Unsteadiness with walking?
  • Weight gain or weight loss?

Moderate Dementia (Can last for two to 10 years)

  • Memory loss about recent events
  • Trouble with simple tasks such as washing dishes or setting the table
  • Trouble picking out the right clothes
  • Forgetting to shave or bathe
  • Believing things are real when they are not
  • Wandering, especially at night 
  • Being worried or depressed
  • Often needing close supervision

Individuals who are already patients of Holy Redeemer’s HomeCare program, automatically receive a comprehensive screening and evaluation, complete with recommendations and an action plan. However, this innovative screening and assessment program is open to anyone with a physician’s order, and, in some cases, verification of homebound status and insurance approval

For more information, please call 1-888-678-8678.


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