Table.
Recommendations for Screening and Counseling Based on Dementia Stage*
| Stage of Dementia | Clinical Features | Screening Questions for the Patient and Family/Informant | Recommendations |
|---|---|---|---|
| Mild cognitive impairment (CDR scale score, 0.05) | Mild memory loss Objective cognitive deficits on testing Intact ADLs, although these may require more effort |
Is there access to firearms at home? Has the patient’s judgment, insight, or personality changed? Does the patient have depressive symptoms? |
Consider neuropsychological or psychiatric referral for definition and treatment of the condition. Enact interval reassessment of cognition and ability. Consider assessment or training by a firearms specialist (if judgment or insight is not impaired)†. Engage the patient in planning for future changes (e.g., a firearm trust or designating a responsible family member or friend). |
| Mild dementia (CDR scale score, 1) | Moderate memory loss interfering with ≥1 ADL Patients are usually aware of some deficits but lack full insight Possible behavioral symptoms, such as hostility or delusions |
Is there access to firearms at home? Has the patient’s judgment, insight, or personality changed? Does the patient have depressive symptoms? |
Enact interval reassessment of cognition and ability. Educate the patient and family about supervised access to home firearms (check ownership laws in the jurisdiction). Counsel the patient/family to restrict access to firearms if appropriate. If the patient has intact judgment and insight and is willing to be supervised, consider a practical firearms update course. If psychosis or other behavior problems are present or the patient refuses to allow restricted access, consider informing authorities and at-risk persons. |
| Moderate and severe dementia (CDR scale score, 2–3) | Severe memory loss interfering with many ADLs and impairments in visuospatial and executive function and praxis Usually personality and behavior changes May not recognize friends or family |
Is there access to firearms at home? | The patient should not have access to any firearm. Consider immediate risk if the patient has access and behavior, depressive, or personality problems. Family/support system should remove firearms and ensure that restrictions are always present. If the patient does not permit restriction or there is an inadequate family/support system or imminent risk for harm, consider informing authorities and at-risk persons. |
ADL = activity of daily living; CDR = clinical dementia rating.
*
Adapted from reference 7. See also Morris JC. The clinical dementia rating (CDR): current version and scoring rules. Neurology. 1993;43:2412–4. [PMID: 8232972].
†
Although Patel and colleagues (7) suggest retraining, no evidence-based standardized assessment or retraining protocol is available.