Hui-Fen Mao1, Ling-Hui Chang2, Athena Yi-Jung Tsai3, Wen-Ni Wennie Huang4, Li-Yu Tang5, Huey-Jane Lee5, Yu Sun6, Ta-Fu Chen7, Ker-Neng Lin8,9, Pei-Ning Wang8,10, Yea-Ing Lotus Shyu11, Ming-Jang Chiu7,12,13. 1. School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. 2. Department of Occupational Therapy, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. 3. Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan. 4. Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan. 5. Taiwan Alzheimer's Disease Association, Taipei, Taiwan. 6. Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan. 7. Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. 8. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. 9. Department of Psychology, Soochow University, Taipei, Taiwan. 10. Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 11. School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan. 12. Graduate Institute of Brain and Mind Sciences, Graduate Institute of Psychology, National Taiwan University, Taipei, Taiwan. 13. Graduate Institute of Biomedical Engineering and Bioinformatics, National Taiwan University, Taipei, Taiwan.
Abstract
BACKGROUND: many people living with dementia remain underdiagnosed and unrecognised. Screening strategies are important for early detection. OBJECTIVE: to examine whether the Lawton's Instrumental Activities of Daily Living (IADL) scale, compared with other cognitive screening tools-the Mini-Mental State Examination (MMSE), and the Ascertain Dementia 8-item Informant Questionnaire (AD8)-can identify older (≥ 65 years) adults with dementia. DESIGN: population-based cross-sectional observational study. SETTING: all 19 counties in Taiwan. PARTICIPANTS: community-dwelling older adults (n = 10,340; mean age 74.87 ± 6.03). METHODS: all participants underwent a structured in-person interview. Dementia was identified using National Institute on Aging-Alzheimer's Association core clinical criteria for all-cause dementia. Receiver operator characteristic curves were used to determine the discriminant abilities of the IADL scale, MMSE and AD8 to differentiate participants with and without dementia. RESULTS: we identified 917 (8.9%) participants with dementia, and 9,423 (91.1%) participants without. The discriminant abilities of the MMSE, AD8 and IADL scale (cutoff score: 6/7; area under curve = 0.925; sensitivity = 89%; specificity = 81%; positive likelihood ratio = 4.75; accuracy = 0.82) were comparable. Combining IADL with AD8 scores significantly improved overall accuracy: specificity = 93%; positive likelihood ratio = 11.74; accuracy = 0.92. CONCLUSIONS: our findings support using IADL scale to screen older community-dwelling residents for dementia: it has discriminant power comparable to that of the AD8 and MMSE. Combining the IADL and the AD8 improves specificity.
BACKGROUND: many people living with dementia remain underdiagnosed and unrecognised. Screening strategies are important for early detection. OBJECTIVE: to examine whether the Lawton's Instrumental Activities of Daily Living (IADL) scale, compared with other cognitive screening tools-the Mini-Mental State Examination (MMSE), and the Ascertain Dementia 8-item Informant Questionnaire (AD8)-can identify older (≥ 65 years) adults with dementia. DESIGN: population-based cross-sectional observational study. SETTING: all 19 counties in Taiwan. PARTICIPANTS: community-dwelling older adults (n = 10,340; mean age 74.87 ± 6.03). METHODS: all participants underwent a structured in-person interview. Dementia was identified using National Institute on Aging-Alzheimer's Association core clinical criteria for all-cause dementia. Receiver operator characteristic curves were used to determine the discriminant abilities of the IADL scale, MMSE and AD8 to differentiate participants with and without dementia. RESULTS: we identified 917 (8.9%) participants with dementia, and 9,423 (91.1%) participants without. The discriminant abilities of the MMSE, AD8 and IADL scale (cutoff score: 6/7; area under curve = 0.925; sensitivity = 89%; specificity = 81%; positive likelihood ratio = 4.75; accuracy = 0.82) were comparable. Combining IADL with AD8 scores significantly improved overall accuracy: specificity = 93%; positive likelihood ratio = 11.74; accuracy = 0.92. CONCLUSIONS: our findings support using IADL scale to screen older community-dwelling residents for dementia: it has discriminant power comparable to that of the AD8 and MMSE. Combining the IADL and the AD8 improves specificity.