Making the most of your visit with the healthcare provider
Use this tool to report changes in your loved one's Alzheimer's symptoms to their healthcare provider—to help them determine an appropriate treatment plan for your loved one
This tool is a resource for caregivers. The tool and the final report are not intended to suggest that any treatment for Alzheimer's disease, including NAMZARIC® (memantine HCl and donepezil HCl), may provide a benefit to any of the specific symptoms presented or identified.
For each symptom, use the drop-down lists to select whether or not this is a new symptom (Yes or No) and how frequently you've noticed this symptom since your loved one's last appointment:
Loss of memory of recent events/confusion
Problems with spoken/written communication
Getting lost/losing things
Difficulty managing personal finances (paying bills)
Difficulty with household tasks and using common household devices (laundry, making meals, microwave)
Problems with personal care (getting dressed, bathing, grooming, toileting)
Loss of interest/withdrawal
Thinking about your loved one over the past month, please list your top concerns that you would like the healthcare provider to be aware of:
Questions to ask about treatment with once-daily NAMZARIC:
Below are some questions you may want to ask your loved one’s healthcare provider at the next appointment:
- Does my loved one have moderate or severe Alzheimer's?
- I recently learned about NAMZARIC, do you think it could be right for my loved one?
- What are possible side effects of NAMZARIC?
- What should I expect to see after my loved one starts treatment with NAMZARIC?
Please answer the questions above in red.
