Instrumental activities of daily living scale for dementia screening in elderly people

Abstract

Objective:To develop and validate an Instrumental Activities of Daily Living Scale for elderly people (IADL-E) to use in conjunction with cognitive screening tests for dementia in an educationally and socioculturally heterogeneous population.Method: Eleven IADL items were selected and weighted for major factors causing heterogeneity in the population -gender, education, social (rural/urban) setting and age. Each item was rated for its applicability (yes/no), degree of disability (scored from 0 to 2) and causative impairment (cognitive and/or physical). From this a composite index of cognitive (CDI) or physical (PDI) disability was derived. Validation was performed retrospectively on 240 subjects: 135 without and 105 with dementia by DSM-IV. Results: The IADL-E had a high internal consistency (α = 0.95). The area under the receiver operating characteristic (ROC) curve was 0.97 (CI = 0.94-0.99). A cutoff score of 16 on CDI provided a sensitivity of 0.91, specificity 0.99 and positive predictive value 0.76 (at 5% base rate). IADL-E correlated highly with clinical (DSM-IV, κ = 0.89), functional (CDR, 0.82) and cognitive (Mini-mental Status Examination, MMSE, 0.74) diagnoses. It showed good responsiveness, with the change on CDI over a median of 23 months correlating significantly with that on MMSE (coefficient = -0.382, CI = -0.667 to -0.098; p = 0.009). Individual items had good interrater and test-retest reliability. 461 462 P. S. Mathuranath et al. Conclusions:The IADL-E is a reliable, sensitive and responsive scale of functional abilities useful in dementia screening in a socioculturally heterogeneous population.

The Diagnosis of Dementia: Diagnostic Accuracy of an Instrument Measuring Activities of Daily Living in a Clinic-Based Population

“…We cannot, of course, exclude the possibility that other ADL scales, of which there are many [ 21 , pp 127-162], might show better performance characteristics; this has been suggested for a recently reported purpose-designed scale for elderly people, IADL-E [35] . Longitudinal, rather than cross-sectional, use of ADL scales might also be more informative [28] .…”

Mild cognitive impairment and dementia in a heterogeneous elderly population: prevalence and risk profile

“…81 Several IADL scales are in use and even though their psychometric properties need to be further established 82 , they have been shown to discriminate between the demented and non-demented as well as detect mild dementia with minimum effects of age, gender and education. 81 IADL scales have been shown to be 'reliable, sensitive and responsive' and useful in dementia screening in a heterogeneous Indian population 83 , with acceptable efficiency for dementia screening. 84 They have been shown to compare favourably against the MMSE when administered by General Practitioners and have the advantage of being simple and nonthreatening to administer.…”

Transition from Cognitively Impaired Not Demented to Alzheimer’s Disease: An Analysis of Changes in Functional Abilities in a Dementia Clinic Cohort

“…In particular, limitations in instrumental activities of daily living (IADL) have been a strong predictor of progression to dementia, with the risk increasing as a function of the number of impaired IADL [12] . Beyond ADL, recent studies have demonstrated that impairment in complex everyday competencies requiring high-level social and cognitive functioning is more prevalent in subjects with MCI compared to healthy controls [13][14][15] . We hypothesized that the identification and characterization of early impairments in IADL and complex social-cognitive competencies would be predictive of progression of CIND.…”