Daily symptom diary

Why a diary matters

Memory can be unreliable for recent events. A brief daily diary captures patterns that the family member or the person themselves may miss: how often a symptom occurs, what triggers it, what helps, and how it changes over time. Two weeks of diary entries provide substantial information for any clinical appointment.

What to capture each day

A useful daily entry might cover the following, in 5 to 10 minutes:

Cognition

• Memory: any notable forgetfulness or repetition (with examples);
• Word-finding: any difficulty articulating;
• Orientation: did the person seem clear about day, place, people;
• Attention: was the person more easily distracted than usual.

Behaviour and mood

• Mood: low, anxious, irritable, content;
• Engagement: did the person initiate activity, or wait to be prompted;
• Any agitation, restlessness or wandering;
• Any psychotic features (hallucinations, delusions, misidentification);
• Sundowning: was there a worse period in the late afternoon.

Sleep

• Time to bed and time of waking;
• Number of night-time waking episodes;
• Daytime napping;
• Dream enactment or unusual movements during sleep.

Physical

• Appetite and weight;
• Fluid intake;
• Bowel and bladder;
• Mobility and any falls;
• Pain;
• Any new physical symptoms (cough, urinary symptoms, breathlessness).

Activity

• What activities the person did;
• Time outdoors;
• Social contact;
• Exercise.

Medication

• All doses taken as prescribed: yes or any missed;
• Any new medications;
• Any side effects noticed.

A simple format

For families who prefer brevity, a one-line entry per day works well:

"Mon 12 May: ACE-style memory lapses x 3 (repeated questions about Sarah's visit). Mood OK. Sundowning around 5pm, music helped. Slept 10pm to 6am, one waking. Appetite reduced. Two falls averted. Walked 30 min."

Longer entries are useful where specific symptoms are being tracked or where a particular question is being investigated.

How to use the diary

• Keep entries brief; daily is more useful than detailed but sporadic;
• Capture examples with quotes where helpful;
• Note any pattern (better mornings, worse afternoons; better with company; better at weekends);
• Bring to the next GP, memory clinic or specialist appointment.

Specific situations

Suspected sundowning

Track the time of behavioural symptoms over a week to identify the peak hour. Helps target interventions.

Suspected Delirium

Where you suspect a sudden change, note the time of onset, what may have triggered it, and any physical symptoms. Same-day GP review.

Tracking response to medication

Track symptoms before and after a medication change. Gives the clinician objective information for the next review.

Suspected REM Sleep Behaviour Disorder

Sleep partner's observations of dream enactment, calling out, shouting, fighting movements. Particularly useful if Dementia with Lewy Bodies is in the differential.

Privacy and dignity

The diary should be kept where the family can use it but where it does not undermine the person's dignity. Some people are happy to be included in keeping the diary; others find it intrusive. Use the format that fits your family.