Simone Reppermund1, Rachael C Birch2, John D Crawford3, Jacqueline Wesson4, Brian Draper3, Nicole A Kochan3, Julian N Trollor5, Katharina Luttenberger6, Henry Brodaty7, Perminder S Sachdev3. 1. Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Medicine, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, Sydney, Australia. Electronic address: s.reppermund@unsw.edu.au. 2. Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Medicine, Sydney, Australia. 3. Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, Sydney, Australia. 4. Ageing Work & Health Research Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia. 5. Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Medicine, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, Sydney, Australia. 6. Zentrum für Medizinische Versorgungsforschung, Psychiatrische und Psychotherapeutische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, UNSW Medicine, Sydney, Australia. 7. Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, Sydney, Australia; Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, UNSW Medicine, Sydney, Australia.
Abstract
OBJECTIVES: The distinction between dementia and mild cognitive impairment (MCI) relies upon the evaluation of independence in instrumental activities of daily living (IADL). Self- and informant reports are prone to bias. Clinician-based performance tests are limited by long administration times, restricted access, or inadequate validation. To close this gap, we developed and validated a performance-based measure of IADL, the Sydney Test of Activities of Daily Living in Memory Disorders (STAM). DESIGN: Prospective cohort study (Sydney Memory and Ageing Study). SETTING: Eastern Suburbs, Sydney, Australia. PARTICIPANTS: 554 community-dwelling individuals (54% female) aged 76 and older with normal cognition, MCI, or dementia. MEASUREMENTS: Activities of daily living were assessed with the STAM, administered by trained psychologists, and the informant-based Bayer-Activities of Daily Living Scale (B-ADL). Depressive symptoms were measured with the Geriatric Depression Scale (15-item version). Cognitive function was assessed with a comprehensive neuropsychological test battery. Consensus diagnoses of MCI and dementia were made independently of STAM scores. RESULTS: The STAM showed high interrater reliability (r = 0.854) and test-retest reliability (r = 0.832). It discriminated significantly between the diagnostic groups of normal cognition, MCI, and dementia with areas under the curves ranging from 0.723 to 0.948. A score of 26.5 discriminated between dementia and nondementia with a sensitivity of 0.831 and a specificity of 0.864. Correlations were low with education (r = 0.230) and depressive symptoms (r = -0.179), moderate with the B-ADL (r = -0.332), and high with cognition (ranging from r = 0.511 to r = 0.594). The mean time to complete the STAM was 16 minutes. CONCLUSIONS: The STAM has good psychometric properties. It can be used to differentiate between normal cognition, MCI, and dementia and can be a helpful tool for diagnostic classification both in clinical practice and research.
OBJECTIVES: The distinction between dementia and mild cognitive impairment (MCI) relies upon the evaluation of independence in instrumental activities of daily living (IADL). Self- and informant reports are prone to bias. Clinician-based performance tests are limited by long administration times, restricted access, or inadequate validation. To close this gap, we developed and validated a performance-based measure of IADL, the Sydney Test of Activities of Daily Living in Memory Disorders (STAM). DESIGN: Prospective cohort study (Sydney Memory and Ageing Study). SETTING: Eastern Suburbs, Sydney, Australia. PARTICIPANTS: 554 community-dwelling individuals (54% female) aged 76 and older with normal cognition, MCI, or dementia. MEASUREMENTS: Activities of daily living were assessed with the STAM, administered by trained psychologists, and the informant-based Bayer-Activities of Daily Living Scale (B-ADL). Depressive symptoms were measured with the Geriatric Depression Scale (15-item version). Cognitive function was assessed with a comprehensive neuropsychological test battery. Consensus diagnoses of MCI and dementia were made independently of STAM scores. RESULTS: The STAM showed high interrater reliability (r = 0.854) and test-retest reliability (r = 0.832). It discriminated significantly between the diagnostic groups of normal cognition, MCI, and dementia with areas under the curves ranging from 0.723 to 0.948. A score of 26.5 discriminated between dementia and nondementia with a sensitivity of 0.831 and a specificity of 0.864. Correlations were low with education (r = 0.230) and depressive symptoms (r = -0.179), moderate with the B-ADL (r = -0.332), and high with cognition (ranging from r = 0.511 to r = 0.594). The mean time to complete the STAM was 16 minutes. CONCLUSIONS: The STAM has good psychometric properties. It can be used to differentiate between normal cognition, MCI, and dementia and can be a helpful tool for diagnostic classification both in clinical practice and research.