Detecting functional decline from normal aging to dementia: Development and validation of a short version of the Amsterdam IADL Questionnaire

Roos J Jutten, Carel F W Peeters, Sophie M J Leijdesdorff, Pieter Jelle Visser, Andrea B Maier, Caroline B Terwee, Philip Scheltens, Sietske A M Sikkes, Roos J Jutten, Carel F W Peeters, Sophie M J Leijdesdorff, Pieter Jelle Visser, Andrea B Maier, Caroline B Terwee, Philip Scheltens, Sietske A M Sikkes

Abstract

Introduction: Detecting functional decline from normal aging to dementia is relevant for diagnostic and prognostic purposes. Therefore, the Amsterdam IADL Questionnaire (A-IADL-Q) was developed: a 70-item proxy-based tool with good psychometric properties. We aimed to design a short version while preserving its psychometric quality.

Methods: Study partners of subjects (n = 1355), ranging from cognitively normal to dementia subjects, completed the original A-IADL-Q. We selected the short version items using a stepwise procedure combining missing data, Item Response Theory, and input from respondents and experts. We investigated internal consistency of the short version and concordance with the original version. To assess its construct validity, we additionally investigated concordance between the short version and the Mini-Mental State Examination (MMSE) and Disability Assessment for Dementia (DAD). Finally, we investigated differences in instrumental activities of daily living (IADL) scores between diagnostic groups across the dementia spectrum.

Results: We selected 30 items covering the entire spectrum of IADL functioning. Internal consistency (0.98) and concordance with the original version (0.97) were very high. Concordance with the MMSE (0.72) and DAD (0.87) scores was high. IADL impairment scores increased across the spectrum from normal cognition to dementia.

Discussion: The A-IADL-Q short version (A-IADL-Q-SV) consists of 30 items and has maintained the psychometric quality of the original A-IADL-Q. As such, the A-IADL-Q-SV is a concise measure of functional decline.

Keywords: Alzheimer's disease; Dementia; Functional decline; Instrumental activities of daily living; Item Response Theory; Mild cognitive impairment; Subjective cognitive decline.

Figures

Fig. 1
Fig. 1
Example item of the A-IADL-Q, including response options and scoring. Abbreviation: A-IADL-Q, Amsterdam IADL Questionnaire.
Fig. 2
Fig. 2
Flowchart of the item selection procedure that led to the short version of the Amsterdam IADL Questionnaire (A-IADL-Q). Abbreviations: IADL, Instrumental Activities of Daily Living; IRT, Item Response Theory.
Fig. 3
Fig. 3
Item information curves of the 30 Amsterdam IADL items that resulted in the short version. The bold black line represents the total test information curve. The latent trait ranges from −4 (good IADL functioning) to +4 (poor IADL functioning). Abbreviation: IADL, instrumental activities of daily living.
Fig. 4
Fig. 4
Short version latent trait scores for each diagnostic group. Latent trait scores reflect IADL functioning, with higher scores indicating poorer IADL functioning. Post hoc analyses gave the following significant pairwise differences: (1) NC versus all other groups; (2) SCD versus AD dementia, non-AD dementia, and Other group; and (3) MCI versus AD dementia. Abbreviations: AD, Alzheimer's disease; IADL, instrumental activities of daily living; MCI, mild cognitive impairment; NC, normal cognition; SCD, subjective cognitive decline.

References

    1. American Psychiatric Association . 5th ed. American Psychiatric Publishing; Arlington, VA: 2013. Diagnostic and Statistical Manual of Mental Disorders.
    1. Lawton M.P., Brody E.M. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–186.
    1. Albert M.S., Dekosky S.T., Dickson D., Dubois B., Feldman H.H., Fox N.C. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:270–279.
    1. Petersen R.C., Caracciolo B., Brayne C., Gauthier S., Jelic V., Fratiglioni L. Mild cognitive impairment: a concept in evolution. J Intern Med. 2014;275:214–228.
    1. Luck T., Luppa M., Wiese B., Maier W., van den Bussche H., Eisele M. Prediction of incident dementia: impact of impairment in instrumental activities of daily living and mild cognitive impairment—results from the German study on ageing, cognition, and dementia in primary care patients. Am J Geriatr Psychiatry. 2012;20:943–954.
    1. Tabert M.H., Albert S.M., Borukhova-Milov L., Camacho Y., Pelton G., Liu X. Functional deficits in patients with mild cognitive impairment: prediction of AD. Neurology. 2002;58:758–764.
    1. Rockwood K. The measuring, meaning and importance of activities of daily living (ADLs) as an outcome. Int Psychogeriatr. 2007;19:467–482.
    1. Woodcock J., Sharfstein J.M., Hamburg M. Regulatory action on rosiglitazone by the US Food and Drug Administration. N Engl J Med. 2010;363:1489–1491.
    1. Vellas B., Andrieu S., Sampaio C., Coley N., Wilcock G. Endpoints for trials in Alzheimer's disease: a European task force consensus. Lancet Neurol. 2008;7:436–450.
    1. Vellas B., Bateman R., Blennow K., Frisoni G., Johnson K., Katz R. Endpoints for Pre-Dementia AD Trials: a report from the EU/US/CTAD Task Force. J Prev Alzheimers Dis. 2015;2:128–135.
    1. Marshall G.A., Amariglio R.E., Sperling R.A., Rentz D.M. Activities of daily living: where do they fit in the diagnosis of Alzheimer's disease? Neurodegener Dis Manag. 2012;2:483–491.
    1. Rosenberg L., Kottorp A., Winblad B., Nygård L. Perceived difficulty in everyday technology use among older adults with or without cognitive deficits. Scand J Occup Ther. 2009;16:216–226.
    1. Sikkes S.A., de Lange-de Klerk E.S., Pijnenburg Y.A., Scheltens P., Uitdehaag B.M. A systematic review of Instrumental Activities of Daily Living scales in dementia: room for improvement. J Neurol Neurosurg Psychiatry. 2009;80:7–12.
    1. Law L.L., Barnett F., Yau M.K., Gray M.A. Measures of everyday competence in older adults with cognitive impairment: a systematic review. Age Ageing. 2012;41:9–16.
    1. Gold D.A. An examination of instrumental activities of daily living assessment in older adults and mild cognitive impairment. J Clin Exp Neuropsychol. 2012;34:11–34.
    1. Jekel K., Damian M., Wattmo C., Hausner L., Bullock R., Connelly P.J. Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review. Alzheimers Res Ther. 2015;7:17.
    1. Kaur N., Belchior P., Gelinas I., Bier N. Critical appraisal of questionnaires to assess functional impairment in individuals with mild cognitive impairment. Int Psychogeriatr. 2016;28:1425–1439.
    1. Sikkes S.A., de Lange-de Klerk E.S., Pijnenburg Y.A., Gillissen F., Romkes R., Knol D.L. A new informant-based questionnaire for instrumental activities of daily living in dementia. Alzheimers Dement. 2012;8:536–543.
    1. Sikkes S.A., Knol D.L., Pijnenburg Y.A., de Lange-de Klerk E.S., Uitdehaag B.M., Scheltens P. Validation of the Amsterdam IADL Questionnaire(c), a new tool to measure instrumental activities of daily living in dementia. Neuroepidemiology. 2013;41:35–41.
    1. Sikkes S.A., Pijnenburg Y.A., Knol D.L., de Lange-de Klerk E.S., Scheltens P., Uitdehaag B.M. Assessment of instrumental activities of daily living in dementia: diagnostic value of the Amsterdam Instrumental Activities of Daily Living Questionnaire. J Geriatr Psychiatry Neurol. 2013;26:244–250.
    1. Koster N., Knol D.L., Uitdehaag B.M., Scheltens P., Sikkes S.A. The sensitivity to change over time of the Amsterdam IADL Questionnaire©. Alzheimers Dement. 2015;11:1231–1240.
    1. van der Flier W.M., Pijnenburg Y.A., Prins N., Lemstra A.W., Bouwman F.H., Teunissen C.E. Optimizing patient care and research: the Amsterdam Dementia Cohort. J Alzheimers Dis. 2014;41:313–327.
    1. Mckhann G.M., Knopman D.S., Chertkow H., Hyman B.T., Jack C.R., Kawas C.H. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:263–269.
    1. Graff-Radford N.R., Ferman T.J., Lucas J.A., Johnson H.K., Parfitt F.C., Heckman M.G. A cost effective method of identifying and recruiting persons over 80 free of dementia or mild cognitive impairment. Alzheimer Dis Assoc Disord. 2006;20:101–104.
    1. Yesavage J.A., Brink T.L., Rose T.L., Lum O., Huang V., Adey M. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1983;17:37–49.
    1. Welsh K.A., Butters N., Mohs R.C., Beekly D., Edland S., Fillenbaum G. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part V. A normative study of the neuropsychological battery. Neurology. 1994;44:609.
    1. Hughes C.P., Berg L., Danziger W.L., Coben L.A., Martin R. A new clinical scale for the staging of dementia. Br J Psychiatry. 1982;140:566–572.
    1. Embretson S.E., Reise S.P. Psychology Press; New York, NB: 2013. Item Response Theory for Psychologists.
    1. Samejima F. Estimation of latent ability using a response pattern of graded scores. Psychometrika. 1970;35:139.
    1. Reise S.P., Waller N.G. Item response theory and clinical measurement. Annu Rev Clin Psychol. 2009;5:27–48.
    1. Chang C.H., Reeve B.B. Item response theory and its applications to patient-reported outcomes measurement. Eval Health Prof. 2005;28:264–282.
    1. Edelen M.O., Reeve B.B. Applying item response theory (IRT) modeling to questionnaire development, evaluation, and refinement. Qual Life Res. 2007;16:5–18.
    1. Mokkink L.B., Terwee C.B., Patrick D.L., Alonso J., Stratford P.W., Knol D.L. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63:737–745.
    1. Folstein M.F., Folstein S.E., McHugh P.R. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198.
    1. Gelinas I., Gauthier L., McIntyre M., Gauthier S. Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. Am J Occup Ther. 1999;53:471–481.
    1. R Core Team . R Foundation for Statistical Computing; Vienna, Austria: 2013. R: A Language and Environment for Statistical Computing.
    1. IBM . IBM Corp; New York: 2011. IBM SPSS Statistics for Windows, version 20.0.
    1. Rizopoulos D. ltm: an R package for latent variable modeling and item response theory analyses. J Stat Softw. 2006;17:1–25.
    1. Raîche G., Walls T.A., Magis D., Riopel M., Blais J.G. Non-graphical solutions for Cattell's Scree Test. Methodology. 2013;9:23–29.
    1. van der Ark L.A. Mokken scale analysis in R. J Stat Softw. 2007;20:183–208.
    1. van Schuur W. vol. 169. Sage Publications; Los Angeles: 2011. (Ordinal Item Response Theory: Mokken Scale Analysis).
    1. Maydeu-Olivares A. Goodness-of-fit assessment of item response theory models. Meas Interdiscip Res Perspect. 2013;11:71–101.
    1. Zhang Z., Yuan K.H. Robust coefficients alpha and omega and confidence intervals with outlying observations and missing data: methods and software. Educ Psychol Meas. 2016;76:387–411.
    1. Kendall M.G., Babington B. The problem of m rankings. Ann Math Stat. 2016;10:275–287.
    1. Dunn O.J. Multiple comparisons using rank sums. Technometrics. 1964;6:241–252.
    1. Farias S.T., Mungas D., Reed B.R., Harvey D., Cahn-Weiner D., Decarli C. MCI is associated with deficits in everyday functioning. Alzheimer Dis Assoc Disord. 2006;20:217–223.
    1. Pedrosa H., De Sa A., Guerreiro M., Maroco J., Simoes M.R., Galasko D. Functional evaluation distinguishes MCI patients from healthy elderly people—the ADCS/MCI/ADL scale. J Nutr Health Aging. 2010;14:703–709.
    1. Teng E., Becker B.W., Woo E., Cummings J.L., Lu P.H. Subtle deficits in instrumental activities of daily living in subtypes of mild cognitive impairment. Dement Geriatr Cogn Disord. 2010;30:189–197.
    1. Jessen F., Amariglio R.E., Van Boxtel M., Breteler M., Ceccaldi M., Chételat G. A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer's disease. Alzheimers Dement. 2014;10:844–852.
    1. Snyder P.J., Kahle-Wrobleski K., Brannan S., Miller D.S., Schindler R.J., Desanti S. Assessing cognition and function in Alzheimer's disease clinical trials: do we have the right tools? Alzheimers Dement. 2014;10:853–860.
    1. Tsutakawa R.K., Johnson J.C. The effect of uncertainty of item parameter estimation on ability estimates. Psychometrika. 1990;55:371–390.
    1. Jorm A. Complaints of cognitive decline in the elderly: a comparison of reports by subjects and informants in a community survey. Psychol Med. 1997;24:365–374.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren