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. 2014 Aug 7;30(4):337–340. doi: 10.1177/1533317514545867

Table 1.

Recommendations for Firearms Screening Based on Stages of Dementia (Adapted from “Firearms and Dementia: A Smoking Gun?.” 9 ).

Stage of Dementia  Presenting Features Screening Recommendations
Mild cognitive impairment (CDR = 0.5)

  1. Mild memory loss

  2. Objective cognitive deficits with testing

  3. Intact ADL, although they may require more effort

  1. Firearms in home? Loaded and unlocked?

  2. Judgment, insight, personality changes?

  3. Depressive symptoms?

  1. If no evidence of impairment in judgment or insight, and no behavior or depressive symptoms, recommend practical firearms update course

  2. Otherwise, consider neuropsychological or psychiatric referral for definition and treatment of condition

  3. Interval reassessment of cognition and ability
Mild dementia (CDR = 1)

  1. Moderate memory loss, interfering with at least one ADL

  2. Patients are usually aware of some deficits but lack full insight

  3. There may be behavioral symptoms such as hostility or delusions

 Obtain information from patient and informant (family) regarding:

  1. Firearms in home? Loaded and unlocked?

  2. Judgment, insight, personality changes?

  3. Depressive symptoms?

  1. Educate patient and family about supervised access to home firearms (check ownership law in jurisdiction)

  2. Counsel patient/family to restrict access to firearms if appropriate

  3. If psychosis or other behavior problems are present, or if patient refuses to allow restrictions in access, inform authorities and at risk individuals

  4. If patient has intact judgment and insight, and is willing to be supervised, recommend practical firearms update course and interval reassessment of cognition and ability
Moderate and severe dementia (CDR = 2-3)

  • Severe memory loss interfering with multiple ADLs and impairments in:

    1. Visuospatial and executive function

    2. Praxis

  • Usually has personality and behavior changes

  • May not recognize friends, family

 Obtain information from patient and informant (family) regarding:
Firearms in home? Loaded and unlocked?

  1. Should not have access to any firearm.

  2. Consider immediate risk if patient has access and there are behavior, depressive, or personality problems. Consider involving law enforcement.

  3. Family/support system should remove firearms and ensure restrictions in force 24 × 7 to prevent patient access

  4. If patient does not permit restriction or if there is inadequate family/support system, inform authorities and at risk individuals

Abbreviations: CDR, clinical dementia rating scale 8 ; ADLs, activities of daily living.