Sheffield Memory Service & Complex Geriatric Care

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

Sheffield Memory Service &
Complex Geriatric Care

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Sheffield Memory Service & Complex Geriatric Care

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

Medication Benefit Review

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- Step 1 of 4

These medications often work by slowing decline rather than producing obvious improvement. A response of "no change" may itself represent a good outcome in a progressive condition.

Please answer based on the period since treatment was started.

to What life

1. Informant details

Full name *

First

Last

Phone *

Email *

Relationship with the patient *

2. Patient details

Full name *

Date of birth *

3. Medication adherence

Medication and current dose *

Donepezil 5mg
Donepezil 10mg
Rivastigmine patch 4.2mg/24hr patch
Rivastigmine patch 9.5mg/24hr
Memantine 5mg OD
Memantine 10mg OD
Memantine 20mg OD
NONE

In the past month, how often were doses missed? *

Never
Occasionally (1-3 times/week)
Weekly
Frequently

4. Perceived benefit

Since starting the medication, compared with before treatment:

1. Overall memory *

Much better
Slightly better
No change
Slightly worse
Much worse

2. Attention and concentration *

Much better
Slightly better
No change
Slightly worse
Much worse

3. Ability to hold a conversation *

Much better
Slightly better
No change
Slightly worse
Much worse

4. Day-to-day functioning (managing everyday activities) *

Much better
Slightly better
No change
Slightly worse
Much worse

5. Mood and motivation *

Much better
Slightly better
No change
Slightly worse
Much worse

6. Behaviour (less agitation, anxiety or irritability) *

Much better
Slightly better
No change
Slightly worse
Much worse

7. Sleep *

Much better
Slightly better
No change
Slightly worse
Much worse

8. Overall quality of life *

Much better
Slightly better
No change
Slightly worse
Much worse

5. Overall impression

9. Overall impression of the medication *

Very helpful
Somewhat helpful
No noticeable benefit
Unsure

10. Would you wish to continue this medication? *

Yes
No
Unsure

Comments

What improvements, if any, have you noticed since starting the medication? *

Have you experienced any side effects or concerns?

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 South Yorkshire.

Private Geriatrician Clinics in Sheffield

Spire Claremont Hospital
401 Sandygate Road
Sheffield S10 5UB

Circle Thornbury Hospital
312 Fulwood Road
Sheffield S10 3BR

📍 Sheffield, South Yorkshire, UK

Home visits also available across Sheffield and surrounding areas.

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