Instrumental Activities of Daily Living Scales to Detect Cognitive Impairment and Dementia in Low- and Middle-Income Countries: A Systematic Review

Journal of Alzheimer's Disease

Yemm, H., Robinson, D. L., et al. (2021).

Journal of Alzheimer's Disease, 83(1), 451-474.

This systematic review investigates the psychometric properties (e.g., sensitivity, specificity) of instrumental activities of daily living (IADL) tools adapted for populations in low- and middle-income countries (LMIC) for identifying dementia or cognitive impairment in adults, 50 years and older.

National Institute for Health Research (United Kingdom)

From database inception to April 2020

English-language studies reporting statistical assessment of the diagnostic accuracy or validity of IADL measures.

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For identifying mild cognitive impairment (MCI), this review identified two IADL tools that were either translated or translated and adapted for LMIC populations: the Activities of Daily Living Questionnaire (ADL-Q) and the Direct Assessment of Function Scale (DAFS). The ADL-Q translated to Portuguese identified MCI from controls with 66% sensitivity and 69% specificity and distinguished between MCI and Alzheimer's disease (AD) with 93% sensitivity and 91% specificity. The DAFS translated to Portuguese and adapted to improve relevance for Brazilian culture identified MCI from controls with 68-80.6% sensitivity and 63-84.4% specificity and distinguished between MCI and AD with 89% sensitivity and 83% specificity. The authors note the limitations of including only English-language studies and of failing to include tools that combine IADL and cognitive assessment. Due to the limited evidence available, the authors highlight the need for choosing culturally appropriate tools that can be conducted quickly and easily. Additional research on IADL tools for populations in LMICs is warranted.

For identifying dementia, studies investigated translated, translated and adapted, and newly developed IADL tools for LMIC populations. <br /> <ul> <li><span style="color: #333333;">The Disability Assessment for Dementia Scale (DADS) translated to Portuguese identified dementia from controls with 94.6% sensitivity and 100% specificity. </span></li> <li><span style="color: #333333;">The Functional Activities Questionnaire (FAQ) translated to Portuguese identified dementia from controls with 80-85.3% sensitivity and 72-76.5% specificity. </span></li> <li><span style="color: #333333;">The Direct Assessment of Function Scale (DAFS) translated to Portuguese and adapted for Brazilian culture identified dementia from controls with 100% sensitivity and 93.7% specificity. </span></li> <li><span style="color: #333333;">The Alzheimer's Disease Cooperative Study - Activities of Daily Living Scale (ADCS-ADLS) translated to Portuguese and adapted for Brazilian culture identified dementia from controls with 97% sensitivity and 70% specificity. </span></li> <li><span style="color: #333333;">The Everyday Abilities Scale for India (EASI) developed for rural Indian populations identified dementia from controls with 62.5% sensitivity and 89.7% specificity. </span></li> <li><span style="color: #333333;">The IDEA-Instrumental Activities of Daily Living Scale (IDEA-IADL) administered in community-based rural Tanzania significantly predicted dementia (0.868; </span><em style="color: #333333;">p</em><span style="color: #333333;">&lt;0.001). </span></li> </ul> <span style="color: #333333;">The authors note the limitation of including only English-language studies and of failing to include tools that combine IADL and cognitive assessment. Due to the limited evidence available, the authors make no recommendation for any particular IADL tool for identifying dementia in LMIC populations, but they highlight the need for choosing culturally appropriate tools that can be conducted quickly and easily. Additional research on IADL tools for populations in LMICs is warranted.</span>