Carer Global Impression of Change (CGIC)

Sheffield Memory Service
& Geriatric care

Specialist in Memory Assessment, Parkinson’s disease, Stroke, Dizziness & Complex Ageing

Sheffield Memory Service
& Geriatric Care

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Sheffield Memory Service
& Geriatric care

Specialist in Memory Assessment, Parkinson’s disease, Stroke, Dizziness & Complex Ageing

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- Step 1 of 3

Informant details

Name *

First

Last

Phone *

Email *

Relationship with patient *

Partner/Spouse
Relative
Professional Carer

Patient details

Name *

First

Last

Date of birth *

Global impression

Overall, compared with before starting the medication, how would you rate the patient's condition?

Very much improved
Much improved
Slightly improved
No noticeable change
Slightly worse
Much worse
Very much worse

1. Domain ratings (Compared with before treatment)

Memory *

Much better
Slightly better
No change
Slightly worse
Much worse

Thinking and concentration *

Much better
Slightly better
No change
Slightly worse
Much worse

Ability to manage everyday activities (dressing, washing, preparing meals, shopping, taking medication, household tasks) *

Much better
Slightly better
No change
Slightly worse
Much worse

Communication *

Much better
Slightly better
No change
Slightly worse
Much worse

Mood and behaviour (anxiety, agitation, irritability, motivation, sleep) *

Much better
Slightly better
No change
Slightly worse
Much worse
Not applicable

Independence *

Much more independent
Slightly more independent
No change
Slightly less independent
Much less independent

Quality of life *

Much better
Slightly better
No change
Slightly worse
Much worse

2. Caregiver burden

Compared with six months ago, how would you describe the demands of caring for the patient? *

Much easier
Slightly easier
No change
Slightly harder
Much harder

3. Overall benefit and continuation

if Overall, Caregiver

Overall, do you feel the medication has been beneficial? *

Yes, definitely
Probably yes
Unsure
Probably not
Definitely not

Would you recommend continuing this medication if it remains well tolerated? *

Yes
Unsure
No

Carer comments

What positive changes have you noticed?

What concerns do you still have?

Is there anything else you would like the clinician to know?

Together We Can Do More

Spire Claremont Hospital

0114 263 0330

Circle Thornbury Hospital

0114 266 1133

Sheffield Memory Service & Geriatric Care

Private Geriatrician in Sheffield specialising in memory assessment, dementia diagnosis, Parkinson’s disease, Stroke & TIA, dizziness, falls and complex ageing care.

This service provides rapid access to consultant-led Comprehensive Geriatric Assessment for older adults in Sheffield and Yorkshire.

Dr Pravin Jha, Consultant Geriatrician & Specialist Physician. GMC reference number 4755744 (view on the GMC register).

Private Geriatrician Clinics in Sheffield

Spire Claremont Hospital
401 Sandygate Road, Sheffield S10 5UB

Circle Thornbury Hospital
312 Fulwood Road, Sheffield S10 3BR

LivingCare
Canon Medical Arena, Sheffield Medical Diagnostic Centre, Sheffield Olympic Legacy Park, Worksop Road, Sheffield, S9 3TL

Home visits also available within 50 miles of Sheffield.

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