Carer Global Impression of Change (CGIC)

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- Step 1 of 3

Informant details

Name *

First

Last

Phone *

Email *

Relationship with patient *

• Partner/Spouse
• Relative
• Professional Carer

tolerated? medication, how

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

Next

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

Next

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

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?

Submit

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