Diagnostic accuracy of Instrumental Activities of Daily Living for dementia in community-dwelling older adults

Hui Fen Mao, Ling-Hui Chang, Athena Yi Jung Tsai, Wen Ni Wennie Huang, Li Yu Tang, Huey Jane Lee, Yu Sun, Ta Fu Chen, Ker Neng Lin, Pei Ning Wang, Yea Ing Lotus Shyu, Ming Jang Chiu

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)551-557
Number of pages7
JournalAge and ageing
Volume47
Issue number4
DOIs
Publication statusPublished - 2018 Jan 1

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Independent Living
Activities of Daily Living
Dementia
Aptitude
National Institute on Aging (U.S.)
Taiwan
Area Under Curve
Observational Studies
Cross-Sectional Studies
Interviews

All Science Journal Classification (ASJC) codes

  • Ageing
  • Geriatrics and Gerontology

Cite this

Mao, Hui Fen ; Chang, Ling-Hui ; Tsai, Athena Yi Jung ; Huang, Wen Ni Wennie ; Tang, Li Yu ; Lee, Huey Jane ; Sun, Yu ; Chen, Ta Fu ; Lin, Ker Neng ; Wang, Pei Ning ; Shyu, Yea Ing Lotus ; Chiu, Ming Jang. / Diagnostic accuracy of Instrumental Activities of Daily Living for dementia in community-dwelling older adults. In: Age and ageing. 2018 ; Vol. 47, No. 4. pp. 551-557.
@article{48446f774a1842d3b3f75cf7fa529e4c,
title = "Diagnostic accuracy of Instrumental Activities of Daily Living for dementia in community-dwelling older adults",
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.",
author = "Mao, {Hui Fen} and Ling-Hui Chang and Tsai, {Athena Yi Jung} and Huang, {Wen Ni Wennie} and Tang, {Li Yu} and Lee, {Huey Jane} and Yu Sun and Chen, {Ta Fu} and Lin, {Ker Neng} and Wang, {Pei Ning} and Shyu, {Yea Ing Lotus} and Chiu, {Ming Jang}",
year = "2018",
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doi = "10.1093/ageing/afy021",
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Mao, HF, Chang, L-H, Tsai, AYJ, Huang, WNW, Tang, LY, Lee, HJ, Sun, Y, Chen, TF, Lin, KN, Wang, PN, Shyu, YIL & Chiu, MJ 2018, 'Diagnostic accuracy of Instrumental Activities of Daily Living for dementia in community-dwelling older adults', Age and ageing, vol. 47, no. 4, pp. 551-557. https://doi.org/10.1093/ageing/afy021

Diagnostic accuracy of Instrumental Activities of Daily Living for dementia in community-dwelling older adults. / Mao, Hui Fen; Chang, Ling-Hui; Tsai, Athena Yi Jung; Huang, Wen Ni Wennie; Tang, Li Yu; Lee, Huey Jane; Sun, Yu; Chen, Ta Fu; Lin, Ker Neng; Wang, Pei Ning; Shyu, Yea Ing Lotus; Chiu, Ming Jang.

In: Age and ageing, Vol. 47, No. 4, 01.01.2018, p. 551-557.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diagnostic accuracy of Instrumental Activities of Daily Living for dementia in community-dwelling older adults

AU - Mao, Hui Fen

AU - Chang, Ling-Hui

AU - Tsai, Athena Yi Jung

AU - Huang, Wen Ni Wennie

AU - Tang, Li Yu

AU - Lee, Huey Jane

AU - Sun, Yu

AU - Chen, Ta Fu

AU - Lin, Ker Neng

AU - Wang, Pei Ning

AU - Shyu, Yea Ing Lotus

AU - Chiu, Ming Jang

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

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