Grade 1: Mild memory impairment
Grade 2: Moderate memory impairment; limiting instrumental ADL
Grade 3: Severe memory impairment; limiting self-care ADLs
Characterize the symptom (onset, pace)
Ask the patient:
Have you had any problems with forgetfulness in the past? Is the melanoma known to be in your brain? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Are you taking any new medications, supplements, or marijuana?
Grade the symptom
Ask the patient:
How forgetful are you? Is it affecting your ability to take care of yourself?
Ask the patient:
Do you have any severe head pain with vision changes, fever, nausea and vomiting while feeling confused or tired? Do you have a headache plus a stiff neck? Have you had any sleepiness, hallucinations, seizures? Do you have any lumps in the front of your throat/difficulty swallowing?
Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?
Patients with severe or worse forgetfulness should be seen.
Patients with any of the red-flag symptoms should be seen immediately.
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What do you suspect is the cause of the forgetfulness?