COSMIN database

A systematic review of Instrumental Activities of Daily Living scales in dementia: room for improvement

Sikkes, S. A., de Lange-de Klerk, E. S., Pijnenburg, Y. A., Scheltens, P., and Uitdehaag, B. M.
BACKGROUND: Instrumental Activities of Daily Living (IADL) questionnaires can be helpful in diagnosing dementia and are often used for clinical follow-up and treatment evaluation in dementia patients. Despite the large number of questionnaires, their quality has received little attention.

OBJECTIVE: To systematically review the measurement properties of all available structured informant-based (I)ADL questionnaires, developed or validated for use in demented patients.

METHODS: A systematic literature search was conducted in MEDLINE, PsycINFO and EMBASE for psychometric articles on (I)ADL questionnaires. In addition, reference lists of all retrieved articles were screened. Standardised criteria were used to assess the quality of the measurement properties. When possible, investigators were contacted to obtain missing information. Two authors independently extracted studies and performed the quality assessment of the questionnaires.

FINDINGS: Thirty-two articles were selected, covering 12 (I)ADL questionnaires. Information on 52.3% of the quality aspects was not available, 32.4% of the ratings were indeterminate, 8.1% were positive, and 7.2% were negative. Out of eight measurement properties, two scales (the DAD and the Bristol ADL) received two positive ratings and were classified as of moderate quality. Five scales (ADL-PI, ADL-IS, B-ADL, CSADL and Lawton IADL) received one positive rating.

INTERPRETATION: The findings indicate that improvements in and more data on psychometric properties of (I)ADL questionnaires for dementia patients are necessary in order to justify their use.
J Neurol Neurosurg Psychiatry
1468-330X (Electronic)
Publication year:
Functional status:
Cognitive/mental functioning
Adults (18-65)
Seniors (65+)
Mental and behavioural disorders and related symptoms
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
ADCS-ADL - Alzheimer Disease Cooperative Study-Activities of Daily Living Inventory
ADCS-ADL-sev - Alzheimer Disease Cooperative Study-Activities of Daily Living Severe
ADL-IS - Alzheimer Disease Activities of Daily Living-International Scale
ADL-PI - Activities of Daily Living-Prevention Instrument
ADLQ - Activities of Daily Living Questionnaire
B-ADL - Bayer Activities of Daily Living Scale
Blessed DS - Blessed Dementia rating Scale
Bristol ADL - Bristol Activities of Daily Living Scale
CSADL - Cleveland Scale for Activities of Daily Living
DAD - Disability Assessment for Dementia
IDDD - Interview for Deterioration in Daily Living Activities in Dementia
Lawton IADL - Lawton Instrumental Activities of Daily Living Scale