Neuropsych History Checklist

  • Depression
  • Elation and Mania
  • Restlessness
  • Autonomic sx
  • Delusions
  • Hallcinations
Personality and Social Conduct
  • Avolition: Lack of motivation [get-up-and-go behaviour]
  • Apathy: deterioration of eating, grooming, hygiene, table manners
  • Asociality / Dysociality
    • loss of social graces -> faux pas, dirty jokes, inappropriate sexual behaviour
    • Childish / ego centric behaviour
    • Disinhibition
    • Lack of empathy -> [eg, diminished response to other people’s needs or feelings; diminished social interest, interrelatedness,
      or personal warmth]
  • Impulsivity
  • Emotional Blunting
  • perseverative, stereotyped, compulsive/ritualistic behavior [eg, simple repetitive movements or complex compulsive or ritualistic behaviors]
  • Insomnia
  • Hypersomnia
  • Parasomnia
  • OSA
  • Incr or Decr Appetite / Wt gain, Wt loss
  • Craving for sweet food
  • Stereotypical pattern [Timing/Type/Anorexia/Bulimia/Rumination]
  • Suicide
  • Safety
  • Lose track of thoughts?
  • difficulty following TV program or movie?
  • gets easily distracted?
  • Anterograde
    • Misplace objects?
    • Repeat questions and/or conversations?
    • Rapidly forget what is told to him/her?
    • Use compensatory strategies (eg, makes notes as reminders)?
    • Mix up dates?
    • Forget appointments?
    • Leave stove on/faucet running?
  • Semantic
    • forget names?
  • Retrograde
    • recollects past personal events?
  • Have word-finding difficulty (eg, peoples’ names, common words/objects)?
  • Make speech sound/word errors (phonemic and/or semantic paraphasias)?
  • Show comprehension deficits (eg, with complex oral instructions, simple oral instructions, written text)?
  • Have pronunciation/articulation deficits?
  • Show loss of word meaning?
  • Have slurred speech?
  • Not always make sense when speaking?
  • Have reduced speech?
Calculation and Executive function [plan, set goal, execute, monitor]
  • Have difficulty planning/organizing (eg, vacations)?
  • Have difficulty multitasking (eg, planning or cooking a meal)?
  • Show poor judgment/bad decisions?
  • Have difficulty with problem solving?
  • Show mental rigidity or inflexibility?
  • difficulty handling money, shopping, bank, bills?
Visuo-spatial/geographic orientation
  • Have trouble navigating (eg, gets lost in familiar places, in unfamiliar territory, own household)?
  • Have prosopagnosia (ie, trouble recognizing familiar faces, objects/buildings)?
  • Have trouble finding objects in a refrigerator or drawer or directly in front of them?
  • Have trouble parking the car, resulting in new dents, or drive too close to others?
  • able to respond to people and objects on both sides?
  • unaware of sensory stimuli on one side of the body?
Visual perception
  • color identification problem?
ADL / IADL [if not already covered]
  • able to do shopping, housework, accounting, food prep, telephone?
  • need help with dressing, eating, ambulation, toileting, hygiene?
  1. When was the first problem observed?
  2. Onset – Acute, Insidious, Stuttering
  3. Enquire about particular difficulties in various day to day settings
    • work
    • housework
    • driving
    • using money
    • hobbies
    • social encounters
  1. Birth and early development
  2. Organ systems review: heart, lung, liver, kidney, skin, joint, eye, thyroid
  3. Hypertension
  4. Diabetes
  5. Head injury
  6. Seizures or Spells
  7. Substance use
  8. Current Medications
  9. Family history of neuropsychiatric disorder
  1. Constitutional symptoms: fever, malaise, weight loss, pain complaints
  2. Neurological symptoms:
    • Headache
    • CN1: Sensation of smell, abnormal smells
    • CN2: Loss or blurring of vision
    • CN3,4,6: Diplopia, squint
    • CN5: Numbness of the face, tingling of face, difficulty chewing
    • CN7: Slurring of speech, drooping of angle of mouth, drooling, stasis of food
    • CN8: difficulty hearing, tinnitus, vertigo, dizziness
    • CN9, 10: Dysarthria, swallowing disturbance
    • weakness or sensory loss, clumsiness, gait disturbance, falls, alteration of urinary or defecatory function, altered sexual function, tremors, tics, spasms
  3. Paroxysmal limbic phenomena:
    • micropsia, macropsia, metamorphopsia
    • déjà vu and jamais vu, déjà écouté and jamais écouté
    • forced thoughts or emotions
    • depersonalization/derealization
    • autoscopy
    • paranormal experiences such as clairvoyance or telepathy
  4. Endocrine symptoms:
    • heat or cold sensitivity
    • constipation or diarrhea
    • rapid heart rate
    • alopecia or change in texture of hair
    • change in skin pigmentation
    • change in menses
  5. Rheumatic disease symptoms:
    • joint pain or swelling
    • mouth ulcers, dry mouth or eyes, rash
    • past spontaneous abortions

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